Operative Timing and Feasibility of Mitral Valve Repair in Active Infective Endocarditis

Area of Science:

• Cardiovascular Surgery
• Infectious Diseases
• Cardiac Valve Surgery

Background:

• Active infective endocarditis (IE) poses significant risks to cardiac structures, particularly the mitral valve (MV).
• The optimal timing for surgical intervention in active IE remains a critical consideration for patient outcomes.
• Mitral valve repair is preferred over replacement when feasible, but its success in IE is debated.

Purpose of the Study:

• To investigate the association between the timing of surgery and the feasibility of mitral valve (MV) repair in patients with active infective endocarditis (IE).
• To evaluate operative outcomes and complication rates based on different operative timings in active IE patients.

Main Methods:

• A retrospective study of 49 active IE patients undergoing MV operations.
• Patients were categorized into three groups based on operative timing: within 48 hours (Term I), 3-14 days (Term II), and ≥15 days (Term III).
• Feasibility of MV repair was assessed using a complexity and severity score system, considering lesion extent and technical challenges.

Main Results:

• No significant differences in patient profiles were observed across the three operative timing groups.
• Higher rates of major complications (86%) and in-hospital mortality (43%) were noted in the urgent group (Term I) compared to later timings.
• The feasibility and frequency of mitral valve repair were similar across all operative timing groups (55-59%).

Conclusions:

• Urgent surgical intervention in active infective endocarditis is associated with increased morbidity and mortality.
• The feasibility of mitral valve repair in active IE is primarily determined by the extent of the infected lesion and technical surgical difficulties, rather than the timing of the operation.