Early onset prosthetic valve endocarditis: the Cleveland Clinic experience 1992-1997

Ann Thorac Surg. 2000 May;69(5):1388-92. doi: 10.1016/s0003-4975(00)01135-8.

Abstract

Background: We reviewed all cases of early onset prosthetic valve endocarditis (EO-PVE) occurring less than 12 months after valve operation among 7,043 patients undergoing heart valve replacements or repairs at The Cleveland Clinic between 1992 and 1997.

Methods: Cases were defined by the Duke criteria and identified through prospective surveillance.

Results: Seventy-seven cases of EO-PVE were identified (1 per 100 procedures), and during the study period the incidence of EO-PVE decreased from 1.5% (1992 to 1994) to 0.7% (1995 to 1997) (p < 0.01). The incidence of EO-PVE for rings (0.2%; 4 of 1,992) was significantly lower than for mechanical (1.6%; 28 of 1,731) and bioprosthetic valves (1.1%; 41 of 3,320) (p < 0.001). The incidence of EO-PVE was also significantly lower for mitral valve versus aortic valve surgeries (0.6% versus 1.4%, p < 0.001). The most common pathogens causing EO-PVE were coagulase-negative staphylococci (52%), fungi (13%), Staphylococcus aureus (10%), and enterococci (8%). Patients undergoing combined surgical and medical treatment of EO-PVE had a significantly higher 30-day, 2-year, and 3-year survival than medically treated patients, although patients judged to be too ill to survive surgery accounted for two-thirds of the patients treated medically.

Conclusions: There is a 1% incidence rate of EO-PVE among patients undergoing valve operations at our institution, usually caused by coagulase-negative staphylococci, and combined surgical and medical treatment is associated with improved survival compared with medical treatment alone.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Endocarditis / etiology*
  • Endocarditis / microbiology
  • Endocarditis / therapy
  • Endocarditis, Bacterial / etiology
  • Endocarditis, Bacterial / therapy
  • Female
  • Heart Valve Prosthesis Implantation*
  • Humans
  • Male
  • Middle Aged
  • Population Surveillance
  • Postoperative Complications
  • Prospective Studies
  • Prosthesis-Related Infections* / microbiology
  • Prosthesis-Related Infections* / therapy
  • Staphylococcal Infections / etiology
  • Time Factors