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Chapter 8 : Infections of Prosthetic Heart Valves

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Abstract:

Prosthetic valve endocarditis (PVE) occurs in 1 to 9.4% of valve recipients. The PVE studies that were reviewed often lacked comprehensive follow-up information on operated patients and thus may have failed to account for infections that were not treated at the reporting institution. Calderwood et al. found 116 patients with PVE in 2,608 patients that survived valve replacement surgery done from January 1975 through December 1982. Actuarial estimates of cumulative risks in this study were 3.1% at 12 months and 5.7% at 60 months. The increasing incidence of PVE on bioprosthetic valves with time elapsed after the initial postoperative year, combined with the leaflet localization of those late onset infections, suggests that anatomic changes in bioprosthetic valve leaflets over time may increase the susceptibility of these valves to endocarditis. Suspecting that the pathogenesis of some infections would relate to nosocomial events, particularly those occurring during or shortly after surgery, Block et al. coined the term “early PVE” for patients with onset of infection within 60 days of surgery. Cefamandole was more effective than cefazolin in preventing wound infections, particularly those caused by , in cardiac surgery patients. In one randomized double-blind trial, patients undergoing cardiac or major vascular surgery who received vancomycin experienced fewer surgical wound infections than did those who received cefazolin or cefamandole. However, in this study there was no significant difference in surgical wound infection rates between recipients of the various prophylactic antibiotic regimens when one considered patients undergoing cardiac surgery.

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8
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Tables

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Table 1

Cumulative incidence of prosthetic valve endocarditis at times after surgery

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8
Generic image for table
Table 2

Microbiology of prosthetic valve endocarditis

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8
Generic image for table
Table 3

Pathology of infection involving mechanical prosthetic valves

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8
Generic image for table
Table 4

Pathology of porcine bioprosthetic valve endocarditis: Massachusetts General Hospital 1975–1983

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8
Generic image for table
Table 5

Clinical features of prosthetic valve endocarditis: Massachusetts General Hospital, 1964–1975

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8
Generic image for table
Table 6

Sensitivity of echocardiography in the diagnosis of prosthetic valve endocarditis

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8
Generic image for table
Table 7

Antimicrobial therapy for prosthetic valve endocarditis in adults

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8
Generic image for table
Table 8

Indications for cardiac surgery in patients with prosthetic valve endocarditis

Citation: Karchmer A. 2000. Infections of Prosthetic Heart Valves, p 145-172. In Waldvogel F, Bisno A (ed), Infections Associated with Indwelling Medical Devices, Third Edition. ASM Press, Washington, DC. doi: 10.1128/9781555818067.ch8

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