Prosthetic valve endocarditis (inflammation and infection involving the heart valves and lining of the heart chambers) remains associated with a high one-year mortality rate and early valve replacement does not appear to be associated with lower mortality compared with medical therapy according to a study by Tahaniyat Lalani, M.D., M.H.S., of the Naval Medical Center, Portsmouth, Virginia, and colleagues.
PVE occurs in approximately 3 percent to 6 percent of patients within five years of valve implantation and is associated with significant morbidity and mortality, according to the study background.
A total of 1,025 patients with PVE enrolled in the International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) between June 2000 and December 2006 met the study criteria. Of the study participants, 490 patients (47.8 percent) underwent early surgery, and 535 individuals (52.2 percent) received medical therapy alone.
According to the study results, compared with medical therapy, early surgery was associated with lower-in-hospital mortality in the unadjusted analysis and after controlling for treatment selection bias. The lower mortality associated with surgery did not persist after adjustment for survivor bias.
"Approximately one-third of patients with PVE die within one year after diagnosis, with mortality strongly associated with other chronic illness, health care-associated infection, S aureus, and complications of PVE," the study concludes.
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JAMA Intern Med. Published online July 15, 2013. doi:10.1001/jamainternmed.2013.8203