Management of prosthetic valve endocarditis: a clinical challenge

The decision over whether to treat prosthetic valve endocarditis medically or surgically continues to challenge clinicians Prosthetic valve endocarditis (PVE) is a very serious disease. PVE is usually classified as early PVE (that is, acquired perioperatively), and late PVE (resulting from infections unrelated to the valve operation). Early PVE has a much worse prognosis than late PVE. Differences in infective organisms and in the clinical setting explain the dismal prognosis in early PVE and the almost universal need for surgical treatment in this type of PVE. PVE is an uncommon disease, but its frequency seems to be increasing, ranging from 0.1–2.3 per patient-year.1 This increased frequency occurs in late cases because preoperative antibiotic prophylaxis and improved manipulation both during the operation and in the postoperative period have significantly contributed to a decrease in the number of early PVE cases. Transoesophageal echocardiography is an extremely useful diagnostic tool in PVE because it allows early recognition of vegetations that could not be visualised by transthoracic echocardiography; it is also is the best tool to investigate periprosthetic damage and prosthetic dysfunction.2,3 Improvements in surgical techniques have also been reported in recent years.4–6 However, even if these diagnostic and therapeutic advances have occurred …