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Mitral valve repair and replacement in endocarditis: a systematic review of literature

Harm H H Feringa1, Leslee J Shaw, Don Poldermans

  • 1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands. h.feringa@erasmusmc.nl

The Annals of Thoracic Surgery
|January 30, 2007
PubMed
Abstract

Insights

Mitral valve repair offers superior survival and reduced complications compared to replacement in infective endocarditis surgery. This systematic review confirms better in-hospital and long-term outcomes for repair.

Area of Science:

  • Cardiovascular Surgery
  • Infective Endocarditis
  • Valvular Heart Disease

Background:

  • Observational studies suggest better survival with mitral valve repair versus replacement in infective endocarditis.
  • Systematic review needed to assess morbidity and mortality associated with both procedures.

Purpose of the Study:

  • To systematically review and compare the morbidity and mortality rates of mitral valve repair versus replacement in patients with infective endocarditis.

Main Methods:

  • Systematic literature search of Medline for studies on mitral valve surgery in infective endocarditis.
  • Review of 24 studies, abstracting patient data, surgical type, and follow-up outcomes.
  • Meta-regression analysis to evaluate factors influencing prognosis.

Main Results:

  • Mitral valve repair (39% of patients) was associated with significantly lower in-hospital (2.3% vs. 14.4%) and long-term mortality (7.8% vs. 40.5%) compared to replacement (61%).
  • Repair also showed lower rates of early reoperation, cerebrovascular events, late reoperation, recurrent endocarditis, and late cerebrovascular events.
  • Meta-regression confirmed that mitral valve repair predicts better early and late prognosis.

Conclusions:

  • Mitral valve repair is associated with favorable in-hospital and long-term clinical outcomes in patients undergoing surgery for infective endocarditis.
  • Repair demonstrates a significant reduction in mortality and key complications compared to valve replacement.

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