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Endocarditis after mitral valve repair.

A Marc Gillinov1, Christiano N Faber, Joseph F Sabik

  • 1Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Ohio 44195, USA. gillinom@ccf.org

The Annals of Thoracic Surgery
|June 25, 2002
PubMed
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Endocarditis after mitral valve repair often necessitates reoperation. However, if infection is confined to a leaflet, antibiotics alone may suffice, avoiding surgery.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Infectious Diseases

Background:

  • Native valve endocarditis typically responds to antibiotics, but prosthetic valve endocarditis often requires surgery.
  • The optimal management strategy for endocarditis following mitral valve repair remains an area of clinical inquiry.

Purpose of the Study:

  • To evaluate treatment outcomes for patients who develop endocarditis after undergoing mitral valve repair.
  • To determine the efficacy of surgical intervention versus antibiotic therapy alone in this patient population.

Main Methods:

  • A retrospective review of 22 patients treated for endocarditis affecting a previously repaired mitral valve between 1986 and 2000.
  • Analysis of causes for initial mitral valve repair, characteristics of endocarditis, treatment approaches (reoperation vs. antibiotics alone), and follow-up data.

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Main Results:

  • Fifteen patients underwent reoperation, with reoperation-free survival rates of 65% at 30 days, 41% at 1 year, and 26% at 5 years.
  • Seven patients treated with antibiotics alone, despite infection eradication, experienced significant mitral regurgitation (2+ to 4+).
  • Overall survival was high (96% at 30 days, 74% at 1 year, 68% at 5 years), with a low recurrence rate.

Conclusions:

  • Endocarditis after mitral valve repair frequently necessitates repeat surgical intervention.
  • Antibiotic therapy alone may be a viable option for infection limited to a leaflet, potentially avoiding early reoperation.