Anaesthesia considerations: Active Prosthetic Valve Endocarditis with cardiogenic shock

Abstract Prosthetic valve endocarditis (PVE) is an infection of the endocardial surface that occurs on parts of the prosthetic valve due to microbial infestation. It is the most severe form of IE with an incidence of 1 – 6% of patients with valve prosthesis (Delgado V et al, 2023). According to 2023 European Society of Cardiologists (ESC) guidelines for management of endocarditis early PVE (within 6 months of valve surgery) is class I indication of surgery with new valve replacement and complete debridement (Delgado V et al, 2023). Surgery is also an indication in patients presenting with cardiogenic shock and heart failure secondary to PVE. Despite early use of surgical approaches, the nature of redo procedures increase the rate of morbidity and mortality with an inhospital mortality rate of about 20 – 40% (Delgado V et al, 2023). According to the 2023 ESC statistics, eventhough surgery is the best treatment option for PVE, it is performed in only 70% of the indicated cases due to the complexities and extensive postoperative care associated with the same. This article presents management of a patient presenting with cardiogenic shock and heart failure secondary to prosthetic valve endocarditis.