Tailored surgical therapy for acute native mitral valve endocarditis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Cardiac Valve Disease

Background:

• Mitral valve repair is superior for non-infectious valve disease, but its role in infective endocarditis is less defined.
• Acute native mitral valve infective endocarditis requires timely surgical intervention.
• Defining optimal surgical strategies for infective endocarditis is crucial for patient outcomes.

Purpose of the Study:

• To evaluate short- and long-term outcomes of mitral valve repair versus replacement for acute infective endocarditis.
• To establish criteria for selecting between mitral valve repair and replacement in infective endocarditis.
• To compare operative mortality, late survival, and functional status after both procedures.

Main Methods:

• Retrospective analysis of 53 consecutive patients with acute native mitral valve infective endocarditis.
• Patients underwent either mitral valve repair (21) or valve replacement (32).
• Data collected included operative mortality, follow-up duration, ejection fraction, mitral regurgitation grade, and recurrent endocarditis rates.

Main Results:

• Operative mortality was 0% for repair versus 13% for replacement (p=0.14).
• At 5-year follow-up, the repair group had higher survival (85% vs. 73%), better ejection fraction (60% vs. 55%), and less mitral regurgitation (grade 1/4).
• Recurrent endocarditis rates were similar: 10% for repair and 3% for replacement (p=0.34).

Conclusions:

• Mitral valve repair is a safe and effective option for acute native mitral valve infective endocarditis.
• Favorable short- and long-term outcomes support mitral valve repair when technically feasible.
• Valve replacement is indicated for advanced endocarditis with significant annular destruction.