Prosthetic valvular endocarditis. A 12-year review. Circulation

A retrospective examination was made of a total of 48 patients with infected prosthetic cardiac valves implanted in 1,236 patients during 1960-1972. Survival rate of the valvular infections was 40%. The purpose of the study was to determine the factors which aided or decreased patient survival and to develop a program of treatment with antimicrobial agents. Numerous anti-microbics and a variety of dosage schedules were used. Of 19 surviving patients, medical treat-ment alone was effective in 14, despite the continued presence of a valvular prosthesis. Reop-eration was successful in five of nine patients. Lifelong chemoprophylactic or suppressive therapy was shown to be unnecessary to prevent relapse in 12 survivors. Prompt surgical replacement is indicated if antimicrobial therapy fails to eradicate infection of a prosthetic valve. A more systematic approach to antimicrobial therapy should improve survival of medically treated infec-tions. Recommendations are made for prevention and treatment of prosthetic valvular endocarditis. Additional Indexing Words: 'Antibiotic therapy Cardiac surgery Infection DURING THE PAST decades as the use of artificial cardiac valves has become wide