Clinical Presentation and Prognosis of Infective Endocarditis Prosthesis: A Retrospective Study in a Tertiary Cardiology Center

Abstract

Introduction: Prosthetic valve endocarditis (PVE) is a serious infection involving the prosthetic heart valve and the endocardium. It carries high morbidity and mortality, especially in patients with mechanical valves. Aim of the Study: To investigate the clinical, biological, bacteriological, and echocardiographic characteristics of patients with prosthetic valve endocarditis and identify the predictive factors of in-hospital mortality. Patients and Methods: This retrospective, descriptive study was conducted over a period of 5 years, from June 2020 to July 2024, and included 82 cases of PVE diagnosed at a tertiary cardiology center. Results: A total of 82 patients were included, with an average age of 39.12 ± 5.6 years. All patients had mechanical valves, with the infection localized to the mitral valve in 53 cases and the aortic valve in 29 cases. Positive blood cultures were obtained in 36 patients, and Staphylococcus aureus was the most common pathogen, isolated in 26 cases (31.7%), followed by coagulase-negative Staphylococcus in 18 cases (21.95%). Transthoracic and transesophageal echocardiography revealed vegetations in 75 patients (91%), with prosthesis disinsertion in 27 cases and periprosthetic abscesses in 15 cases. The most common complications included heart failure in 17 patients, embolic events in 46 patients, and renal failure in 15 patients. Antibiotic therapy was administered to all patients, with a total average duration of 39.26 days. Surgery was indicated in 62 patients, with an average surgery delay of 42 ± 2 days. The main surgical indications were uncontrolled heart failure (32 cases), embolic complications (17 cases), and failure to control infection with antibiotics (13 cases). The overall mortality rate was 26%. Predictive factors of mortality included heart failure, delayed surgery, and early-onset PVE. Conclusion: Prosthetic valve endocarditis remains a challenging and life-threatening condition. Prompt diagnosis, appropriate antibiotic therapy, and timely surgical intervention are essential for improving patient outcomes. Mortality is influenced by multiple factors, including the timing of the infection and the presence of comorbid conditions.