0298: Prosthetic valve endocarditis. A 15-years cohort study

Introduction Prosthetic valve endocarditis (PVE) is an uncommon complication after valve replacement surgery, but potentially fatal. The scarcity of clinical trials makes harder the diagnostic and therapeutic approach of this entity. Aim To define the clinical characteristics and in-hospital evolution of a population with PVE. Methods Retrospective study based on a sample of 173 patients (P) with the diagnosis of infective endocarditis (IE), according to the modified Duke criteria, admitted from 1998 to 2013. We analyzed demographic and clinical features, complications and in-hospital mortality of P with PVE. Results We found 34 P (20%) with PVE, mean age 60.2±17.6 years with a female predominance (53%). The most common form was the community-acquired IE, registering 11 P (32%) with health care-associated IE. There was a preferential engagement of the mitral valve (56%) and 26% had early PVE. The cardinal complaints at presentation were constitutional symptoms (97%) and fever (74%); 50% of P showed signs of acute heart failure (HF). The most common analytical abnormalities were elevated inflammatory biomarkers (CRP 94% and leukocytosis 41%), anemia (88%) and increased creatinine (60%). The microbial agent was isolated in 24 P (71%), being Staphylococcus spp (26%) and Streptococcus spp (21%) the most common. The prosthesis dehiscence (60%), severe regurgitation (29%) and perivalvular abscess (21%) were the most frequent complications seen at initial echo-cardiographic evaluation. The most common adverse events were acute kidney injury (74%), persistence of HF (56%), septic shock (15%) and stroke (12%). There was need for urgent referral to surgery in 38% of P. The in-hospital mortality was higher than other P with IE (21% vs 13%). Conclusion The PVE is associated with a poor prognosis at short term. Its adverse developments should lead to the early identification of riskier P and timely consideration of the possible benefit of surgery.