Habib G et al. (2005) Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 cases. Heart 91: 954–959

Prosthetic-valve endocarditis (PVE) is regarded as the most serious complication of valve replacement and is associated with a high risk of mortality. There is disagreement, however, over whether surgery or medicine is the more effective treatment strategy. Habib and co-workers addressed this issue in a recent study, which they report to be the largest published series of strict cases of PVE as defined by the DUKE CRITERIA.

A total of 104 consecutive PVE patients were enrolled in this retrospective, nonrandomized study carried out at two French centers. Fifty-one patients were selected by their surgeon and medical team to undergo valve replacement with a bioprosthesis, mechanical valve or homograft (n = 19, 15 and 17, respectively); the rest of the study group underwent medical treatment.

For the group as a whole, the difference between in-hospital mortality in surgical and medical patients was found to be not statistically significant; however, both in-hospital and long-term mortality were lower in surgically treated high-risk patients with staphylococcal PVE or PVE with complications than in those treated medically.

The authors found early PVE (occurring ≤12 months after surgery), congestive heart failure, staphylococcal infection and PVE with complications to be markers of poor outcome. Patients with early staphylococcal PVE and PVE with complications were identified as subgroups for which surgery should be strongly recommended. Because of high long-term mortality results, rigorous follow-up after the first PVE episode is advised.