A Nationwide Study on Mitral Valve Repair vs Replacement for Active Endocarditis

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Medical Device Technology

Background:

• Limited real-world evidence exists on valve repair versus replacement for active mitral valve infective endocarditis.
• Reproducibility and superiority of mitral valve repair over replacement in this context require further investigation.

Purpose of the Study:

• To evaluate the comparative effectiveness of mitral valve repair versus replacement in patients with active infective endocarditis.
• To analyze long-term survival outcomes based on surgical approach.

Main Methods:

• Utilized data from a prospective nationwide database of cardiac surgical procedures in The Netherlands (2013-2020).
• Included adult patients undergoing primary mitral valve intervention for active infective endocarditis.
• Performed survival analysis, including landmark analysis at 90 days and propensity score-adjusted analysis.

Main Results:

• Of 715 patients, 41.1% underwent mitral valve repair; repair rates showed a slight decrease over time.
• Risk-adjusted and propensity score-adjusted analyses indicated significantly inferior outcomes for mitral valve replacement compared to repair (aHR > 2.2, P < .05).
• Early mortality rates declined despite increasing patient complexity.

Conclusions:

• Contemporary mitral valve surgery for infective endocarditis faces growing patient complexity but shows declining early mortality.
• A trend towards decreasing mitral valve repair rates was observed.
• Mitral valve repair is associated with improved late outcomes compared to valve replacement in active infective endocarditis.