Prosthetic valve endocarditis: Indications for surgery

Brief Review Prosthetic valve endocarditis is a life threatening situation and often can be refractory to medical therapy, requiring surgical intervention. Indications for surgery in prosthetic valve endocarditis (PVE) include: Persistent bacteremia after 7-10 days Heart failure Early prosthetic valve endocarditis Fungal endocarditis Paravalvular leak Annular or aortic abscess True or false aneurysm Fistula formation New onset conduction disturbance Recurrent peripheral embolisation despite therapy A best evidence topic review suggested that unless patient is a poor surgical candidate, surgery is the treatment of choice in prosthetic valve endocarditis [1]. They recommended early surgery if there is hemodynamic instability, heart failure, valvular dysfunction, dehiscence or annular absence. In addition they recommended early surgery prosthetic valve endocarditis due to Staphylococcus aureus. PALSUSE score has been developed by Spanish Collaboration on Endocarditis to predict in hospital prognosis for valve surgery in endocarditis [2]. PALSUSE score parameters are prosthetic valve, age 70 years or more, large intracardiac destruction, Staphylococcus, urgent surgery, female gender and a EuroSCORE of 10 or more. They noted a mortality rate of 45.4% in patients with PALSUSE score above 3. Even though heart failure is an important reason for urgent surgery in prosthetic valve endocarditis, it need not indicate a bad prognosis. Large vegetations and uncontrolled infection are ...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery Early prosthetic valve endocarditis Fungal endocarditis PALSUSE score paravalvular leak Source Type: blogs