Surgical repair and replacement for native mitral valve infective endocarditis

Area of Science:

• Cardiovascular Surgery
• Infective Endocarditis
• Valvular Heart Disease

Background:

• The optimal surgical strategy for infective endocarditis involving the mitral valve remains debated.
• Comparing mitral valve repair versus replacement in this specific patient population is crucial for guiding clinical decisions.

Purpose of the Study:

• To evaluate the clinical outcomes of mitral valve repair compared to mitral valve replacement in patients with infective endocarditis.
• To identify patient subgroups that may benefit more from either repair or replacement.

Main Methods:

• A retrospective review of 282 patients undergoing native mitral valve surgery for infective endocarditis between 2001 and 2021.
• Propensity score matching was utilized to create comparable cohorts for mitral valve repair and replacement.

Main Results:

• Mitral valve replacement was more frequent in patients with extensive valve, leaflet, or annular involvement.
• No significant difference in in-hospital mortality or long-term survival (1, 5, and 10 years) was observed between repair and replacement groups.
• Mitral valve repair was associated with isolated single leaflet involvement, while replacement addressed more complex pathologies.

Conclusions:

• Mitral valve repair demonstrates favorable early and 10-year outcomes in selected patients with isolated mitral valve infective endocarditis.
• Mitral valve replacement is a successful option for patients with severe valve, leaflet, or annular destruction due to infective endocarditis.