Impact of Lesion Localization on Durability of Mitral Valve Repair in Infective Endocarditis

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Takashi Miura1, Kikuko Obase1, Tsuneo Ariyoshi1

  • 1Department of Cardiovascular Surgery, Nagasaki University Hospital, Nagasaki, Japan.

The Annals of Thoracic Surgery
|November 30, 2019
PubMed
Abstract

Insights

Mitral valve repair for infective endocarditis is durable when the posterior leaflet or anterior leaflet clear zone is affected. However, anterior leaflet rough zone infections, particularly those involving multiple segments, significantly increase the risk of recurrent mitral regurgitation.

Area of Science:

  • Cardiovascular Surgery
  • Infective Endocarditis Research
  • Mitral Valve Repair Techniques

Background:

  • Mitral valve (MV) repair for infective endocarditis (IE) presents unique surgical challenges.
  • The durability of MV repair is influenced by the specific location of the infectious lesion within the valve.

Purpose of the Study:

  • To investigate the long-term durability of mitral valve repair in patients with infective endocarditis.
  • To correlate the location of the infected lesion with the rate of recurrent mitral regurgitation after repair.

Main Methods:

  • Retrospective analysis of 83 patients who underwent mitral valve repair for infective endocarditis.
  • Classification of patients into types based on lesion location: posterior leaflet (Type I), anterior leaflet clear zone (Type IIC), anterior leaflet rough zone (Type IIR), and annulus (Type III).
  • Subgroup analysis of Type IIR based on lesion size (single vs. multiple segment involvement).

Main Results:

  • Recurrent moderate or severe mitral regurgitation (MR) rates varied by lesion type: 2.8% (Type I), 0% (Type IIC), 28.6% (Type IIR), and 14.3% (Type III).
  • Freedom from recurrent MR was significantly lower in Type IIR (63.1% at 5 years) compared to other types (96.8%).
  • Type IIR lesions, especially large ones (>1 segment), showed higher recurrence rates (55.6%) and were an independent predictor of recurrent MR (HR 11.1).

Conclusions:

  • Mitral valve repair for IE demonstrates satisfactory durability when infection involves the posterior leaflet or anterior leaflet clear zone.
  • Infection of the anterior leaflet rough zone, particularly with extensive involvement, is associated with a high risk of recurrent mitral regurgitation.
  • Lesion location is a critical factor determining the success and durability of mitral valve repair in infective endocarditis.

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