Role of Medical Management in Prosthetic Valve Endocarditis

Prosthetic valve endocarditis (PVE) is a biofilm-associated disease that occurs in individuals with prosthetic heart valves or rings. The most critical clinical decision in the management of PVE is determining whether the patient should undergo surgery. If a decision is made to treat non-surgically, the clinician should be clear about the reason not to operate. Surgery should be considered for all patients with PVE. Antimicrobial selection depends on the causative pathogen. Patients with PVE with an unidentified pathogen, who are expected to undergo surgery in the near future, need not be started on antibiotics prior to surgery if they are stable clinically. The duration of treatment is usually based on common practice that has been shaped by success with prior treatments of durations that have been associated with success.