Repair for active infective atrioventricular valve endocarditis: 23-year single center experience

We retrospectively compared early and long-term results of mitral (MV) and tricuspid valve (TV) repair in patients with isolated active infective atrioventricular valve (AV) endocarditis over a period of 23 years.

Between April 1986 and December 2009, a total of 1,409 patients with active infective endocarditis (AIE) were operated upon. Of these, 106 (7.2%) patients (n = 69 men, age 2-84 years) underwent repair of AVE (MV n = 68, TV n = 38). Repair techniques included vegetectomy and leaflet resection, annular plication and annuloplasty, and pericardial patch leaflet and annular reconstruction without any artificial device. Perioperative characteristics, probability of survival, freedom from recurrence and reoperation, and predictors for early mortality were analyzed. Follow-up (0-23 years) was completed in 95% with a total of 667 patient years.

The 30-day, 1-, 5- and 10-year survival rate for MV repair was 89.7 ± 0.4, 82.2 ± 4.6, 72.6 ± 5.5 and 56.5 ± 7.3% and for TV repair 94.7 ± 3.7, 88.7 ± 5.3, 69.4 ± 8.8 and 64.5 ± 9.5%, respectively (ns). Three patients (2.8%) had to undergo reoperation due to early failure of reconstruction (n = 2 MV, n = 1 TV). Freedom from valve-related reoperation at 1 and 10 years was 88.4 ± 4.1 and 75.4 ± 7.4% for the MV repair and 97.4 ± 2.6 and 93.94 ± 4.2% for the TV repair group (ns). Endocarditis reoccurred early in 2 MV repair patients (1.9%). Freedom from reoperation due to reinfection at 1 and 10 years after MV repair was 96.6 ± 2.3 and 91.6 ± 5.4% and after TV repair 100 and 83.3 ± 9.5%.

Repair for AV endocarditis yields excellent results. It is associated with low operative mortality and provides satisfactory early and long-term survival and favorable freedom from recurrent endocarditis and repeat operation. It should be considered as the primary surgical option in these patients, and AV replacement should be performed only in cases of severe AV destruction that renders repair techniques impossible.