Management of Prosthetic Valve Infective Endocarditis
This study analyzed the profile and outcome of surgically versus medically treated patients with prosthetic valve infective endocarditis (PVE). From 2000 to 2006, 80 patients >16 years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated gr...
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| Veröffentlicht in: | The American journal of cardiology 2008-04, Vol.101 (8), p.1174-1178 |
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| container_title | The American journal of cardiology |
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| creator | Hill, Evelyn E., MD Herregods, Marie-Christine, MD, PhD Vanderschueren, Steven, MD, PhD Claus, Piet, PhD Peetermans, Willy E., MD, PhD Herijgers, Paul, MD, PhD |
| description | This study analyzed the profile and outcome of surgically versus medically treated patients with prosthetic valve infective endocarditis (PVE). From 2000 to 2006, 80 patients >16 years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated group was separated into deliberately conservative and perforce conservative treatments, the latter group including patients with contraindications to a cardiosurgical intervention. The most frequent causative micro-organisms were staphylococci. Forty-six percent of patients were surgically treated, 34% had deliberately conservative treatment, and 20% had perforce conservative treatment. Six-month mortality was 29%; 27% of surgically treated patients died, 4% deliberately conservatively patients died, and 75% perforce conservatively treated patients died. Septic shock, multiorgan failure, and type of treatment were significantly associated with death in univariable analysis. Multivariable analysis revealed that type of treatment (perforce conservative) and septic shock predicted death in patients with PVE. Survival was most favorable in deliberately conservatively treated patients, including PVE due to Staphylococcus aureus . In conclusion, there remains a role for watchful waiting in patients with PVE without evidence of major complications. Moreover, patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. Conversely, patients with major complicated PVE should preferentially undergo surgery. Predictors of mortality in patients with PVE included septic shock and perforce conservative treatment. |
| doi_str_mv | 10.1016/j.amjcard.2007.12.015 |
| format | Article |
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From 2000 to 2006, 80 patients >16 years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated group was separated into deliberately conservative and perforce conservative treatments, the latter group including patients with contraindications to a cardiosurgical intervention. The most frequent causative micro-organisms were staphylococci. Forty-six percent of patients were surgically treated, 34% had deliberately conservative treatment, and 20% had perforce conservative treatment. Six-month mortality was 29%; 27% of surgically treated patients died, 4% deliberately conservatively patients died, and 75% perforce conservatively treated patients died. Septic shock, multiorgan failure, and type of treatment were significantly associated with death in univariable analysis. Multivariable analysis revealed that type of treatment (perforce conservative) and septic shock predicted death in patients with PVE. Survival was most favorable in deliberately conservatively treated patients, including PVE due to Staphylococcus aureus . In conclusion, there remains a role for watchful waiting in patients with PVE without evidence of major complications. Moreover, patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. Conversely, patients with major complicated PVE should preferentially undergo surgery. Predictors of mortality in patients with PVE included septic shock and perforce conservative treatment.</description><identifier>ISSN: 0002-9149</identifier><identifier>EISSN: 1879-1913</identifier><identifier>DOI: 10.1016/j.amjcard.2007.12.015</identifier><identifier>PMID: 18394454</identifier><identifier>CODEN: AJCDAG</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>Aged ; Biological and medical sciences ; Cardiology ; Cardiology. 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From 2000 to 2006, 80 patients >16 years of age (median 71) with definite PVE according to modified Duke criteria were included. The medically treated group was separated into deliberately conservative and perforce conservative treatments, the latter group including patients with contraindications to a cardiosurgical intervention. The most frequent causative micro-organisms were staphylococci. Forty-six percent of patients were surgically treated, 34% had deliberately conservative treatment, and 20% had perforce conservative treatment. Six-month mortality was 29%; 27% of surgically treated patients died, 4% deliberately conservatively patients died, and 75% perforce conservatively treated patients died. Septic shock, multiorgan failure, and type of treatment were significantly associated with death in univariable analysis. Multivariable analysis revealed that type of treatment (perforce conservative) and septic shock predicted death in patients with PVE. Survival was most favorable in deliberately conservatively treated patients, including PVE due to Staphylococcus aureus . In conclusion, there remains a role for watchful waiting in patients with PVE without evidence of major complications. Moreover, patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. Conversely, patients with major complicated PVE should preferentially undergo surgery. Predictors of mortality in patients with PVE included septic shock and perforce conservative treatment.</description><subject>Aged</subject><subject>Biological and medical sciences</subject><subject>Cardiology</subject><subject>Cardiology. 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Vascular system</topic><topic>Cardiovascular</topic><topic>Cardiovascular disease</topic><topic>Endocardial and cardiac valvular diseases</topic><topic>Endocarditis, Bacterial - microbiology</topic><topic>Endocarditis, Bacterial - mortality</topic><topic>Endocarditis, Bacterial - therapy</topic><topic>Female</topic><topic>Heart</topic><topic>Heart Valve Prosthesis - microbiology</topic><topic>Heart Valves - microbiology</topic><topic>Heart Valves - surgery</topic><topic>Humans</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Medical technology</topic><topic>Multiple Organ Failure - mortality</topic><topic>Multivariate Analysis</topic><topic>Orthopedic surgery</topic><topic>Outcome Assessment (Health Care)</topic><topic>Prospective Studies</topic><topic>Prostheses</topic><topic>Prosthesis Failure</topic><topic>Prosthesis-Related Infections - microbiology</topic><topic>Prosthesis-Related Infections - mortality</topic><topic>Prosthesis-Related Infections - therapy</topic><topic>Shock, Septic - mortality</topic><topic>Surgery (general aspects). 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Graft diseases</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Hill, Evelyn E., MD</creatorcontrib><creatorcontrib>Herregods, Marie-Christine, MD, PhD</creatorcontrib><creatorcontrib>Vanderschueren, Steven, MD, PhD</creatorcontrib><creatorcontrib>Claus, Piet, PhD</creatorcontrib><creatorcontrib>Peetermans, Willy E., MD, PhD</creatorcontrib><creatorcontrib>Herijgers, Paul, MD, PhD</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Physical Education Index</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Biochemistry Abstracts 1</collection><collection>Nursing & Allied Health Premium</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>The American journal of cardiology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Hill, Evelyn E., MD</au><au>Herregods, Marie-Christine, MD, PhD</au><au>Vanderschueren, Steven, MD, PhD</au><au>Claus, Piet, PhD</au><au>Peetermans, Willy E., MD, PhD</au><au>Herijgers, Paul, MD, PhD</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Management of Prosthetic Valve Infective Endocarditis</atitle><jtitle>The American journal of cardiology</jtitle><addtitle>Am J Cardiol</addtitle><date>2008-04-15</date><risdate>2008</risdate><volume>101</volume><issue>8</issue><spage>1174</spage><epage>1178</epage><pages>1174-1178</pages><issn>0002-9149</issn><eissn>1879-1913</eissn><coden>AJCDAG</coden><abstract>This study analyzed the profile and outcome of surgically versus medically treated patients with prosthetic valve infective endocarditis (PVE). 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Survival was most favorable in deliberately conservatively treated patients, including PVE due to Staphylococcus aureus . In conclusion, there remains a role for watchful waiting in patients with PVE without evidence of major complications. Moreover, patients with uncomplicated S. aureus PVE can be treated successfully without cardiac surgery. Conversely, patients with major complicated PVE should preferentially undergo surgery. Predictors of mortality in patients with PVE included septic shock and perforce conservative treatment.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>18394454</pmid><doi>10.1016/j.amjcard.2007.12.015</doi><tpages>5</tpages></addata></record> |
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| subjects | Aged Biological and medical sciences Cardiology Cardiology. Vascular system Cardiovascular Cardiovascular disease Endocardial and cardiac valvular diseases Endocarditis, Bacterial - microbiology Endocarditis, Bacterial - mortality Endocarditis, Bacterial - therapy Female Heart Heart Valve Prosthesis - microbiology Heart Valves - microbiology Heart Valves - surgery Humans Male Medical sciences Medical technology Multiple Organ Failure - mortality Multivariate Analysis Orthopedic surgery Outcome Assessment (Health Care) Prospective Studies Prostheses Prosthesis Failure Prosthesis-Related Infections - microbiology Prosthesis-Related Infections - mortality Prosthesis-Related Infections - therapy Shock, Septic - mortality Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases |
| title | Management of Prosthetic Valve Infective Endocarditis |
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