Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable?

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Cardiac Surgery

Background:

• Active native mitral valve (MV) endocarditis is a severe condition requiring prompt surgical intervention.
• A 20-year institutional experience focused on an early and repair-oriented surgical approach for MV endocarditis.

Purpose of the Study:

• To evaluate the outcomes of mitral valve surgery for active endocarditis.
• To compare the efficacy of mitral valve repair versus replacement.
• To assess the long-term durability and recurrence rates associated with MV repair.

Main Methods:

• Retrospective analysis of 192 patients undergoing MV surgery for active endocarditis (1991-2015).
• Comparison of outcomes between MV repair (81%) and MV replacement (19%).
• Analysis of subgroups based on the use of patch material during repair.

Main Results:

• Patients undergoing MV replacement were older and had more comorbidities.
• Hospital mortality was significantly lower in the repair group (11.6%) versus the replacement group (29.7%).
• 15-year overall survival was higher for repair (57%) compared to replacement (36%).
• The linearized rate of recurrent endocarditis was substantially lower with repair (0.1%) than replacement (2.4%).

Conclusions:

• An early and repair-oriented surgical strategy for active MV endocarditis achieves high reparability rates.
• Mitral valve repair demonstrates good long-term durability and a very low recurrence rate of endocarditis.
• Patients can benefit from MV repair, even when patch material is required.