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Early and late results of surgical treatment for isolated active native mitral valve infective endocarditis

Anton Tomšic1, Michel I M Versteegh1, Nina Ajmone Marsan2

  • 1Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, Netherlands.

Interactive Cardiovascular and Thoracic Surgery
|December 23, 2017
PubMed
Abstract

Insights

Mitral valve repair (MVRep) for native infective endocarditis (IE) is feasible in most patients, offering excellent durability. Mitral valve replacement remains an alternative when repair is not possible.

Area of Science:

  • Cardiovascular Surgery
  • Infective Endocarditis Research
  • Valvular Heart Disease

Background:

  • Native mitral valve infective endocarditis (IE) presents significant mortality and morbidity challenges.
  • Mitral valve repair (MVRep) is a viable option for limited valve destruction, but recurrence and reintervention are concerns.

Purpose of the Study:

  • To evaluate the feasibility and durability of an MVRep-oriented surgical approach for native mitral valve IE.
  • To compare outcomes between MVRep and mitral valve replacement in patients with native mitral valve IE.

Main Methods:

  • A retrospective analysis of 83 patients undergoing surgery for isolated active native mitral valve IE between 2000 and 2016.
  • An early surgery, MVRep-focused strategy was employed, utilizing patch techniques for durable repairs. MVRep was attempted in 67% of patients.

Main Results:

  • Early mortality was 13%, with no early recurrent IE. Eight-year survival rates were 92.4% for MVRep and 74.2% for mitral valve replacement (adjusted HR 0.359, P=0.096).
  • Four reinterventions occurred (2 in each group). Echocardiography showed excellent MVRep durability with no mitral regurgitation and one case of mitral stenosis at follow-up.

Conclusions:

  • A durable MVRep is achievable in the majority of patients with native mitral valve IE, demonstrating excellent mid-term durability.
  • The MVRep-oriented approach offers comparable survival to mitral valve replacement, highlighting its efficacy.
  • Mitral valve replacement is a suitable alternative when a durable repair is not anticipated.

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