Native versus primary prosthetic valve endocarditis: comparison of clinical features and long-term outcome in 353 patients.

Despite the significant advances that have beenmade in diagnostic techniques, increased surgicalexperience, and the availability of effective antimicro-bial agents, native valve endocarditis (NVE) and pros-thetic valve endocarditis (PVE) still represent majorsurgical dilemmas. As outlined in a recent authorita-tive review of the literature, most of these difficulties“relate to our mindset in the methods of treatment andthe approach we use in the surgical management ofthis disease.” (1).Although improved outcomes of NVE have beenattained, the role and timing of surgical treatment -along with choice of an adequate substitutional deviceand complementary medical management - remain thesubjects of active debate (2-4). By contrast, PVE stillrepresents an important cause of morbidity and mor-tality after valve replacement surgery. Apart fromhighly selected single-surgeon series which reportencouraging results (5), mortality rates usually rangefrom 20 to 65% (6,7). Due to the low incidence of PVE,single-surgeon experience remains limited, therebyseverely affecting treatment strategies and subsequentoutcome (8). The choice of prosthesis in re-replacementfor PVE is an area of intense controversy (9,10). As PVEyields a different course and outcome compared withNVE, an abundance of reports referring to outcomeanalyses of mixed series has in fact prevented a defini-