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Valvular repair or replacement for mitral endocarditis: 7-year cohort study
Tom Kai Ming Wang1, Timothy Oh2, Jamie Voss2
1Green Lane Cardiovascular Service, Auckland City Hospital, Auckland, New Zealand TWang@adhb.govt.nz.
Asian Cardiovascular & Thoracic Annals
|March 4, 2014
Summary
Mitral valve repair and replacement showed similar outcomes in infective endocarditis patients. Despite higher baseline risks in replacement candidates, operative mortality and morbidity rates were comparable, indicating both are viable options for complex mitral valve disease.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Medical Outcomes Research
Background:
- Limited comparative data exists for mitral valve repair versus replacement in infective endocarditis.
- Previous studies report variable outcomes, necessitating further investigation.
Purpose of the Study:
- To compare the characteristics and outcomes of mitral valve repair and replacement in patients with active infective endocarditis.
- To evaluate operative mortality, morbidity, and long-term results for both procedures.
Main Methods:
- Retrospective analysis of patients undergoing mitral valve repair or replacement for active endocarditis between 2005-2011.
- Prespecified endpoints included operative and follow-up mortality, composite morbidity, recurrent endocarditis, and need for reoperation.
Main Results:
- Valve replacement patients presented with higher baseline risk factors, including older age, intracardiac abscess, prior endocarditis, and poorer renal function.
- Despite these differences, repair and replacement groups demonstrated similar rates of operative mortality, composite morbidity, survival, recurrent endocarditis, and reoperation.
- Independent predictors for adverse outcomes included preoperative support, dialysis, intracardiac abscess, hypercholesterolemia, previous endocarditis, and prior stroke.
Conclusions:
- Mitral valve replacement candidates exhibited more baseline risk factors and higher unadjusted rates of postoperative mortality and morbidity.
- Outcomes were comparable between mitral valve repair and replacement in this cohort of infective endocarditis patients.
- The findings suggest that both surgical approaches can be considered for managing active mitral valve endocarditis.
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