1114. Importance of Surgery in the Management of Prosthetic Valve Endocarditis
Session: Poster Abstract Session: Infections of Cardiovascular Devices
Saturday, October 22, 2011
Room: Poster Hall B1

Background: Treatment guidelines for PVE (AHA Circulation 2005;111:e394) recommend antibiotic therapy, and state that surgery is frequently required in these patients and may be lifesaving. How critical surgery is for the success of treatment in PVE is not well defined.   

Methods: All patients with definite PVE by Duke criteria admitted between July 1, 2007 and June 30, 2009 were divided into those treated medically and those treated surgically at their index hospitalization at the Cleveland Clinic. Treatment failure, defined as death due to any cause or subsequent surgery for active endocarditis, was compared among the two groups. A Cox proportional hazards analysis was done to identify factors independently associated with treatment failure.

Results: Of 98 patients with definite PVE during the 2 year study period, 84% (82 pts) were treated surgically during their index hospitalization. Medically treated patients were older than surgically treated patients (median ages 76 and 63 years, respectively, p-value 0.03, Wilcoxon rank sum test), but the two groups otherwise had similar baseline characteristics. Medically treated PVE (16 pts) had significantly higher treatment failure, than surgically treated PVE (p-value <0.001, log rank test), with one year survival free of surgery for endocarditis of 18% and 73%, respectively, for the two groups (figure). In a Cox proportional hazards model medical treatment (hazard ratio 6.77, 95% CI 3.40 13.12) was the only factor independently associated with treatment failure. Three (19%) of the 16 medically treated patients underwent surgery for endocarditis at a subsequent hospitalization 24, 30, and 97 days after discharge from hospital.  

Conclusion: Surgery is the most important intervention in the management of PVE. Prosthetic valve endocarditis treated without surgery has a dismal outcome.

Figure. Unadjusted hazard plot for medically versus surgically treated PVE (shaded areas represent 95% confidence intervals)

Subject Category: C. Clinical studies of bacterial infections and antibacterials including sexually transmitted diseases and mycobacterial infections (surveys, epidemiology, and clinical trials)

Nabin K. Shrestha, MD, MPH1, Joyce Chung Rii, DO, MA1, Gosta B. Pettersson, MD, PhD2, Robert Butler, MS3 and Steven Gordon, MD, FIDSA1, (1)Infectious Disease, Cleveland Clinic, Cleveland, OH, (2)Cardiothoracic Surgery, Cleveland Clinic, Cleveland, OH, (3)Quantitative Health Sciences, Cleveland Clinic, Cleveland, OH


N. K. Shrestha, Astellas: Consultant, Consulting fee
Cubist: Grant Investigator, Grant recipient
Forest: Speaker's Bureau, Speaker honorarium

J. C. Rii, None

G. B. Pettersson, On-X Life Technologies, Inc.: Consultant, Consulting fee

R. Butler, None

S. Gordon, None

Findings in the abstracts are embargoed until 12:01 a.m. EST Thursday, Oct. 20 with the exception of research findings presented at IDSA press conferences.