In the first five years after valve replacement approximately 3-6 percent of patients will develop prosthetic valve endocarditis (PVE). These patients are much more likely to die. Now a large observational study — the first of its type — has found that surgery is no better than medical therapy in reducing mortality in these patients. The report from the ICE-PCD (International Collaboration on Endocarditis — Prospective Cohort Study) investigators appears in JAMA Internal Medicine.
The trial followed 1,025 PVE patients, about half of whom had surgery (47.8% versus 52.2% who received medical therapy). Mortality, both in-hospital and at 1 year, was significantly lower in the surgery group. This was true using both unadjusted data and a multivariable model using a propensity score. However, after adjusting for survivor bias there were no significant differences between the two groups: