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Surgical repair and replacement for native mitral valve infective endocarditis

Pietro Giorgio Malvindi1, Suvitesh Luthra2, Anna Zingale2

  • 1Cardiac Surgery Unit, Lancisi Cardiovascular Center, Ospedali Riuniti delle Marche, Polytechnic University of Marche, Ancona, Italy.

Journal of Cardiovascular Medicine (Hagerstown, Md.)
|February 26, 2024
PubMed
Abstract

Insights

Mitral valve repair offers good outcomes for isolated leaflet issues in infective endocarditis. Mitral valve replacement is effective for complex cases involving the annulus or both leaflets.

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.

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