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Surgical treatment of mitral valve endocarditis in North America

James S Gammie1, Sean M O'Brien, Bartley P Griffith

  • 1Division of Cardiac Surgery, University of Maryland Medical Center, Baltimore, Maryland 21201, USA. jgammie@smail.umaryland.edu

The Annals of Thoracic Surgery
|November 25, 2005
PubMed
Abstract

Insights

Mitral valve repair is less common for infective endocarditis (IE) but offers lower operative mortality. Repair is associated with reduced death risk, supporting its use when feasible for IE patients.

Area of Science:

  • Cardiovascular Surgery
  • Infective Diseases
  • Medical Device Technology

Background:

  • Single-institution studies suggest mitral valve repair is feasible and effective for infective endocarditis (IE).
  • Large-scale, multi-center data are needed to confirm these findings and assess repair's role in IE management.

Purpose of the Study:

  • To evaluate the utilization and outcomes of mitral valve repair versus replacement in patients with infective endocarditis (IE).
  • To identify factors influencing the choice between mitral valve repair and replacement for IE.
  • To assess the impact of mitral valve repair on operative mortality in IE patients.

Main Methods:

  • Analysis of 6,627 patients with IE undergoing mitral valve surgery from 1994 to 2003.
  • Data sourced from 661 Society of Thoracic Surgeons-participating centers.
  • Comparison of operative mortality and risk factors between mitral valve repair and replacement groups.

Main Results:

  • Mitral valve repair was performed in 29.7% of IE cases, less frequently in active IE (15.9%) than treated IE (40.9%).
  • Operative mortality was significantly lower for mitral valve repair (3.7%) compared to replacement (10.8%).
  • Mitral valve repair was associated with a significantly lower risk of death (OR, 0.67) after adjusting for risk factors.

Conclusions:

  • Mitral valve repair is underutilized in IE compared to other mitral valve surgery indications.
  • Active IE and recent cerebrovascular accident are independent predictors of mortality.
  • Mitral valve repair is associated with reduced mortality and should be considered when technically feasible for IE.

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