Nationwide cohort study of mitral valve repair versus replacement for infective endocarditis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Medical Outcomes Research

Background:

• The long-term outcomes and feasibility of mitral valve (MV) repair in infective endocarditis (IE) patients are not well-established.
• Surgical management of IE often involves valve replacement, but the comparative effectiveness of repair versus replacement requires further investigation.

Purpose of the Study:

• To compare the perioperative and long-term outcomes of mitral valve repair versus replacement in patients with infective endocarditis.
• To evaluate the impact of surgical strategy on mortality, reoperation, stroke, bleeding, and heart failure readmission.

Main Methods:

• A retrospective analysis of 1999 patients undergoing MV surgery for IE from 2000-2013 using Taiwan's National Health Insurance Research Database.
• Propensity score matching created comparable groups of 352 patients each for MV repair and replacement.
• Outcomes assessed included perioperative complications, in-hospital mortality, and a composite of late mortality, MV reoperation, stroke, major bleeding, and heart failure readmission over a mean follow-up of 4.8 years.

Main Results:

• Mitral valve repair was associated with fewer perioperative complications and lower in-hospital mortality (6.3% vs 10.8%).
• Patients undergoing MV repair had significantly lower risks of late mortality (HR 0.59) and the composite endpoint (HR 0.67).
• Repair showed benefits even in active IE and suggested a trend towards less benefit in low-volume hospitals.

Conclusions:

• Mitral valve repair for IE demonstrates superior perioperative and late outcomes compared to mitral valve replacement.
• Mitral valve repair is recommended over replacement for IE patients, particularly when performed by experienced surgical teams, even in cases of active infection.