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Mitral valve repair for bacterial endocarditis
W G Hendren1, A S Morris, E R Rosenkranz
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195-5066.
Abstract:
Twenty-two patients with mitral insufficiency resulting from native valve endocarditis underwent mitral valve repair. Six patients had acute endocarditis with positive blood cultures and active valve infection. Sixteen patients were cured of active infection, but mitral insufficiency developed as a result of prior infection. Mean age was 48.5 +/- 21.7 years; 13 (59%) were male. Mean New York Heart Association functional class was 2.6 +/- 1.2. Multiple valve lesions were present in 11 (50%) patients. Valve abnormalities included leaflet perforation in 13 patients, chordal rupture or elongation in 14, vegetations in 5; and annular abscess in 1. In patients with acute endocarditis all macroscopically infected tissue was excised. Multiple techniques were required to achieve valve competence. Suture or patch closure of perforation was done in 14 patients, chordal shortening or transfer in 9, leaflet resection and closure in 4, leaflet resection with pericardial patching in 5, and annuloplasty in 15. Mitral valvuloplasty was combined with other procedures in 11 (50%) patients. There were two (9%) hospital deaths, both occurring in patients with healed endocarditis. There was one (9%) death in a patient undergoing an isolated procedure and one (9%) in a patient undergoing a combined procedure. Mean follow-up was 24 +/- 16.8 months and was complete. Seventeen (85%) were in New York Heart Association functional class I, and three (15%) were in class II. There were no late deaths, reoperations, recurrent endocarditis, thromboembolic events, or other valve-related morbidity. We conclude that mitral valve repair for insufficiency resulting from bacterial endocarditis (1) is possible in acute and healed disease, (2) has a low operative mortality, and (3) has resulted in patients free of recurrent infection and valve-related morbidity and mortality. Mitral valve repair is an attractive alternate to valve replacement in bacterial endocarditis.
Insights
Mitral valve repair is a viable option for patients with bacterial endocarditis, offering low mortality and excellent long-term outcomes. This procedure effectively addresses mitral insufficiency, avoiding reoperation or recurrent infection.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Native valve endocarditis frequently leads to mitral insufficiency.
- Surgical intervention is often necessary to manage the resulting valve dysfunction.
Purpose of the Study:
- To evaluate the efficacy and safety of mitral valve repair in patients with mitral insufficiency secondary to bacterial endocarditis.
- To assess long-term outcomes, including mortality, reoperation rates, and valve-related morbidity.
Main Methods:
- Retrospective analysis of 22 patients who underwent mitral valve repair for endocarditis-related mitral insufficiency.
- Detailed review of surgical techniques, patient demographics, preoperative and postoperative functional status, and follow-up data.
Main Results:
- Successful valve repair was achieved in the majority of patients, with significant improvement in New York Heart Association functional class.
- Low operative mortality (9%) and no late deaths, reoperations, or recurrent endocarditis were observed.
- Patients experienced no valve-related morbidity or thromboembolic events during a mean follow-up of 24 months.
Conclusions:
- Mitral valve repair is a safe and effective treatment for mitral insufficiency caused by bacterial endocarditis, applicable in both acute and healed stages.
- The procedure demonstrates low operative mortality and excellent long-term results, making it an attractive alternative to valve replacement.