Comparison between mitral valve repair and replacement in active infective endocarditis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Cardiac Surgery Outcomes

Background:

• Mitral valve repair excels in degenerative disease but its efficacy in active endocarditis remains uncertain.
• Patient condition and tissue damage severity may impede successful, durable mitral valve repair.
• Investigating the benefits of mitral valve repair versus replacement during active endocarditis is crucial.

Purpose of the Study:

• To compare the mid-term outcomes of mitral valve repair versus replacement in patients with active left-sided endocarditis.
• To identify factors influencing the choice between mitral valve repair and replacement in endocarditis patients.

Main Methods:

• Retrospective comparison of perioperative data and mid-term outcomes for 114 patients undergoing mitral valve procedures for active endocarditis.
• Patients were divided into mitral valve repair (38) and replacement (76) groups.
• Data collected from January 2006 to December 2017.

Main Results:

• The mitral valve repair group had fewer patients with NYHA class IV (18.4% vs 56.6%) and tended towards better 5-year survival (91.6% vs 70.0%).
• Postoperative moderate to severe mitral regurgitation occurred in 13.2% of the repair group without recurrent endocarditis.
• Mitral valve replacement was more common in patients with decompensated heart failure and combined procedures.

Conclusions:

• Mitral valve repair can be safely performed during active endocarditis with favorable mid-term results.
• Selected patients without extremely high surgical risk may particularly benefit from mitral valve repair.
• Repair offers a potentially better survival estimate compared to replacement in this patient cohort.