Twenty-Year Experience with Surgery for Native and Prosthetic Mitral Valve Endocarditis

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Valve Replacement Surgery

Background:

• Infective endocarditis affecting the mitral valve (native or prosthetic) presents significant surgical challenges.
• Evaluating surgical outcomes for mitral valve endocarditis is crucial for patient management.
• Early and long-term results of surgical interventions require thorough assessment.

Purpose of the Study:

• To assess the early and long-term outcomes of surgical treatment for isolated mitral native and prosthetic valve infective endocarditis.
• To identify risk factors influencing mortality and reintervention rates in these patients.

Main Methods:

• Retrospective review of 130 patients who underwent mitral valve surgery for infective endocarditis between 2001 and 2021.
• Analysis included preoperative/postoperative characteristics, mortality, and reintervention rates.
• Comparison between native and prosthetic valve endocarditis, and between mitral valve repair and replacement.

Main Results:

• Overall mortality was 39% with a mean survival of 11.8 years. Patients >60 years had significantly worse survival (p < 0.001).
• Mitral valve repair showed a trend towards better survival (p=0.06) and was identified as a protective factor.
• Mechanical prosthesis offered better survival than biological prosthesis (p < 0.001). Native valve endocarditis had higher freedom from reintervention (p=0.04).

Conclusions:

• Surgical treatment for mitral valve endocarditis is associated with substantial morbidity and mortality.
• Patient age >60 years is an independent risk factor for mortality.
• Mitral valve repair is recommended when feasible for suitable patients with infective endocarditis.