Valve Replacement in Bacterial Endocarditis

¹ Methodist Hospital and Baylor College of Medicine, Houston, Texas
² Assistant Professor, Department of Medicine
³ Associate Professor, Department of Medicine

Early valve replacement may be required in patients with bacterial endocarditis and severe heart failure before completion of a course of optimal antibiotic therapy. Aortic and/or mitral valve replacement was performed in 32 patients whose antibiotic treatment ranged from a single preoperative dose to a full six-week course. There were ten early deaths and four late deaths, none of which was due to recurrent infection on the prosthesis. Prosthetic endocarditis from a new organism was the cause of one early and one late death. There were 18 patients who survived one month to more than 60 months, three of whom were lost to followup. Two surviving patients required reoperation, one to change a swollen Silastic ball, and the other to replace a partially dehisced prosthesis. In no case was the antibiotic given for more than six post-operatively. Antibiotic prophylaxis after valve replacement is recommended for those who have had acute rheumatic fever and for those in whom instrumentation is contemplated.