Reconstructive surgery in active mitral valve endocarditis: feasibility, safety and durability

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Valvular Heart Disease

Background:

• Active infective endocarditis poses significant risks for complex mitral valve (MV) lesions.
• Timely surgical intervention is crucial for managing these critical conditions.
• Mitral valve repair (MVR) strategies are continuously evolving for active endocarditis.

Purpose of the Study:

• To evaluate the optimal timing for surgery in active mitral valve endocarditis.
• To assess the management and outcomes of complex mitral valve lesions requiring repair.
• To analyze the long-term durability and safety of mitral valve repair in active endocarditis.

Main Methods:

• Retrospective analysis of 81 patients operated for active MV endocarditis between 1993 and 2005.
• Focus on 63 patients (78%) who underwent MV repair, with a median diagnosis-to-surgery time of 10 days.
• Application of diverse surgical techniques, including pericardial patches, tricuspid autografts, homografts, and prosthetic rings.

Main Results:

• Overall operative mortality was 17.5%, reduced to 4.8% in patients with NYHA class I or II.
• Independent risk factors for early mortality included NYHA class > or =3, age >70, and history of valvular disease.
• Five- and 10-year survival rates were 73% and 69%, respectively. Freedom from cardiac death at 5 and 10 years was 93% and 93%.
• Freedom from MV reoperation at 5 and 10 years was 89% and 72%, respectively. Ten-year freedom from MV replacement was 95% and from endocarditis recurrence was 98%.

Conclusions:

• Diverse and advanced techniques achieve an 80% mitral valve repair rate in active endocarditis.
• Mitral valve repair demonstrates high safety and excellent durability, even for complex cases.
• Successful MV repair leads to favorable long-term outcomes with low rates of reoperation and recurrence.