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Surgery for prosthetic valve endocarditis

Adolf W Karchmer, MD
Rakesh M Suri, MD, DPhil
Section Editors
Scott E Kasner, MD
Catherine M Otto, MD
Deputy Editors
Susan B Yeon, MD, JD, FACC
Elinor L Baron, MD, DTMH


Infection of a prosthetic heart valve can be difficult to diagnose and manage. Optimal treatment of prosthetic valve endocarditis (PVE) requires:

Identification of the causative microorganism.

Selection of a bactericidal antimicrobial regimen of proven efficacy.

A clear understanding of the intracardiac pathology and attendant complications of PVE. (See "Epidemiology, clinical manifestations, and diagnosis of prosthetic valve endocarditis".)

Surgical intervention (in selected cases), especially when infection has extended beyond the valve to contiguous cardiac tissue or resulted in major valvular dysfunction.

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Literature review current through: Nov 2017. | This topic last updated: Aug 25, 2017.
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  1. Hill EE, Herregods MC, Vanderschueren S, et al. Management of prosthetic valve infective endocarditis. Am J Cardiol 2008; 101:1174.
  2. Wang A, Athan E, Pappas PA, et al. Contemporary clinical profile and outcome of prosthetic valve endocarditis. JAMA 2007; 297:1354.
  3. Lalani T, Chu VH, Park LP, et al. In-hospital and 1-year mortality in patients undergoing early surgery for prosthetic valve endocarditis. JAMA Intern Med 2013; 173:1495.
  4. Calderwood SB, Swinski LA, Karchmer AW, et al. Prosthetic valve endocarditis. Analysis of factors affecting outcome of therapy. J Thorac Cardiovasc Surg 1986; 92:776.
  5. Baddour LM, Wilson WR, Bayer AS, et al. Infective Endocarditis in Adults: Diagnosis, Antimicrobial Therapy, and Management of Complications: A Scientific Statement for Healthcare Professionals From the American Heart Association. Circulation 2015; 132:1435.
  6. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J 2015; 36:3075.
  7. AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs, Pettersson GB, Coselli JS, et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: Surgical treatment of infective endocarditis: Executive summary. J Thorac Cardiovasc Surg 2017; 153:1241.
  8. Chirouze C, Alla F, Fowler VG Jr, et al. Impact of early valve surgery on outcome of Staphylococcus aureus prosthetic valve infective endocarditis: analysis in the International Collaboration of Endocarditis-Prospective Cohort Study. Clin Infect Dis 2015; 60:741.
  9. Karchmer AW, Bayer AS. Editorial commentary: surgical therapy for Staphylococcus aureus prosthetic valve endocarditis: proceed with caution (Caveat Emptor). Clin Infect Dis 2015; 60:750.
  10. Mihos CG, Capoulade R, Yucel E, et al. Surgical Versus Medical Therapy for Prosthetic Valve Endocarditis: A Meta-Analysis of 32 Studies. Ann Thorac Surg 2017; 103:991.
  11. Wang A, Pappas P, Anstrom KJ, et al. The use and effect of surgical therapy for prosthetic valve infective endocarditis: a propensity analysis of a multicenter, international cohort. Am Heart J 2005; 150:1086.
  12. López J, Sevilla T, Vilacosta I, et al. Clinical significance of congestive heart failure in prosthetic valve endocarditis. A multicenter study with 257 patients. Rev Esp Cardiol (Engl Ed) 2013; 66:384.
  13. Habib G, Tribouilloy C, Thuny F, et al. Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases. Heart 2005; 91:954.
  14. Karchmer AW. Infections of Prosthetic Heart Valves. In: Infections Associated with Indwelling Medical Devices, 3rd ed, Waldvogel FA, Bisno AL (Eds), American Society for Microbiology, Washington, DC 2000. p.145.
  15. Truninger K, Attenhofer Jost CH, Seifert B, et al. Long term follow up of prosthetic valve endocarditis: what characteristics identify patients who were treated successfully with antibiotics alone? Heart 1999; 82:714.
  16. Bolger AF. Challenges in treating prosthetic valve endocarditis. JAMA Intern Med 2013; 173:1504.
  17. Kiefer T, Park L, Tribouilloy C, et al. Association between valvular surgery and mortality among patients with infective endocarditis complicated by heart failure. JAMA 2011; 306:2239.
  18. Karchmer AW, Dismukes WE, Buckley MJ, Austen WG. Late prosthetic valve endocarditis: clinical features influencing therapy. Am J Med 1978; 64:199.
  19. Yu VL, Fang GD, Keys TF, et al. Prosthetic valve endocarditis: superiority of surgical valve replacement versus medical therapy only. Ann Thorac Surg 1994; 58:1073.
  20. Richardson JV, Karp RB, Kirklin JW, Dismukes WE. Treatment of infective endocarditis: a 10-year comparative analysis. Circulation 1978; 58:589.
  21. Horstkotte D, Bircks W, Loogen F. Infective endocarditis of native and prosthetic valves--the case for prompt surgical intervention? A retrospective analysis of factors affecting survival. Z Kardiol 1986; 75 Suppl 2:168.
  22. Baumgartner WA, Miller DC, Reitz BA, et al. Surgical treatment of prosthetic valve endocarditis. Ann Thorac Surg 1983; 35:87.
  23. Boyd AD, Spencer FC, Isom OW, et al. Infective endocarditis. An analysis of 54 surgically treated patients. J Thorac Cardiovasc Surg 1977; 73:23.
  24. Foghsgaard S, Bruun N, Kjaergard H. Outcome of aortic homograft implantation in 24 cases of severe infective endocarditis. Scand J Infect Dis 2008; 40:216.
  25. Reinhartz O, Herrmann M, Redling F, Zerkowski HR. Timing of surgery in patients with acute infective endocarditis. J Cardiovasc Surg (Torino) 1996; 37:397.
  26. Saffle JR, Gardner P, Schoenbaum SC, Wild W. Prosthetic valve endocarditis. The case for prompt valve replacement. J Thorac Cardiovasc Surg 1977; 73:416.
  27. Jault F, Gandjbakhch I, Chastre JC, et al. Prosthetic valve endocarditis with ring abscesses. Surgical management and long-term results. J Thorac Cardiovasc Surg 1993; 105:1106.
  28. Wolff M, Witchitz S, Chastang C, et al. Prosthetic valve endocarditis in the ICU. Prognostic factors of overall survival in a series of 122 cases and consequences for treatment decision. Chest 1995; 108:688.
  29. Røder BL, Wandall DA, Espersen F, et al. A study of 47 bacteremic Staphylococcus aureus endocarditis cases: 23 with native valves treated surgically and 24 with prosthetic valves. Scand Cardiovasc J 1997; 31:305.
  30. Kuyvenhoven JP, van Rijk-Zwikker GL, Hermans J, et al. Prosthetic valve endocarditis: analysis of risk factors for mortality. Eur J Cardiothorac Surg 1994; 8:420.
  31. John MD, Hibberd PL, Karchmer AW, et al. Staphylococcus aureus prosthetic valve endocarditis: optimal management and risk factors for death. Clin Infect Dis 1998; 26:1302.
  32. Chirouze C, Cabell CH, Fowler VG Jr, et al. Prognostic factors in 61 cases of Staphylococcus aureus prosthetic valve infective endocarditis from the International Collaboration on Endocarditis merged database. Clin Infect Dis 2004; 38:1323.
  33. Sett SS, Hudon MP, Jamieson WR, Chow AW. Prosthetic valve endocarditis. Experience with porcine bioprostheses. J Thorac Cardiovasc Surg 1993; 105:428.
  34. Sohail MR, Martin KR, Wilson WR, et al. Medical versus surgical management of Staphylococcus aureus prosthetic valve endocarditis. Am J Med 2006; 119:147.
  35. Gilbert HM, Peters ED, Lang SJ, Hartman BJ. Successful treatment of fungal prosthetic valve endocarditis: case report and review. Clin Infect Dis 1996; 22:348.
  36. Melgar GR, Nasser RM, Gordon SM, et al. Fungal prosthetic valve endocarditis in 16 patients. An 11-year experience in a tertiary care hospital. Medicine (Baltimore) 1997; 76:94.
  37. Nguyen MH, Nguyen ML, Yu VL, et al. Candida prosthetic valve endocarditis: prospective study of six cases and review of the literature. Clin Infect Dis 1996; 22:262.
  38. Steckelberg JM, Murphy JG, Ballard D, et al. Emboli in infective endocarditis: the prognostic value of echocardiography. Ann Intern Med 1991; 114:635.
  39. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J 2009; 30:2369.
  40. Lytle BW, Priest BP, Taylor PC, et al. Surgical treatment of prosthetic valve endocarditis. J Thorac Cardiovasc Surg 1996; 111:198.
  41. d'Udekem Y, David TE, Feindel CM, et al. Long-term results of operation for paravalvular abscess. Ann Thorac Surg 1996; 62:48.
  42. David TE. The surgical treatment of patients with prosthetic valve endocarditis. Semin Thorac Cardiovasc Surg 1995; 7:47.
  43. Pansini S, di Summa M, Patane F, et al. Risk of recurrence after reoperation for prosthetic valve endocarditis. J Heart Valve Dis 1997; 6:84.
  44. Vongpatanasin W, Hillis LD, Lange RA. Prosthetic heart valves. N Engl J Med 1996; 335:407.
  45. Hussain ST, Shrestha NK, Gordon SM, et al. Residual patient, anatomic, and surgical obstacles in treating active left-sided infective endocarditis. J Thorac Cardiovasc Surg 2014; 148:981.
  46. Delay D, Pellerin M, Carrier M, et al. Immediate and long-term results of valve replacement for native and prosthetic valve endocarditis. Ann Thorac Surg 2000; 70:1219.
  47. Edlin P, Westling K, Sartipy U. Long-term survival after operations for native and prosthetic valve endocarditis. Ann Thorac Surg 2013; 95:1551.