John Bartlett, MD

Disclosures

July 23, 2003

In This Article

Prosthetic Valve Endocarditis

Akowuah EF, Davies W, Oliver S, Stephens J, Riaz I, Zadik P, Cooper G. Prosthetic valve endocarditis: early and late outcome following medical or surgical treatment. Heart. 2003;89:269-272. Abstract This is a retrospective analysis from Sheffield, England, of 66 patients with prosthetic valve endocarditis who were treated from 1989 to 1999. The study's objective was to determine outcome for medical vs surgical treatment. Among the 66 patients, 28 were treated medically alone, and 38 received both antibiotics and surgery. The results showed that the inpatient mortality was significantly greater with medical vs surgical treatment (46% vs 24%), but 7 of the 28 medically treated patients were considered too seriously ill for surgical intervention. Thus, the mortality rate in the 21 remaining patients was 29%, which is not significantly different from the mortality rate in the surgical group. The 5-year follow-up showed that the outcomes with surgery and medical management were comparable in terms of recurrence rates of endocarditis. These results are summarized in Table 17 .

The authors conclude that prosthetic valve endocarditis can be managed medically in carefully selected patients and that both medical and surgical therapy can result in favorable long-term outcome.

Comment: There are multiple reports on outcome with surgery vs medical management of endocarditis, but this one is particularly useful in providing an analysis that separates the group of patients treated medically because they were not considered surgical candidates. Nevertheless, the majority of patients did undergo surgery, and the relatively high mortality in both groups illustrates the severity of this complication.

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