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Published on: October 16, 2021
The Role of Microbes in Surgical Decision Making for Infective Endocarditis: Mitral Valve Repair or Replacement?
Elisa Mikus1, Mariafrancesca Fiorentino1, Diego Sangiorgi1
1Cardiovascular Department, Maria Cecilia Hospital, GVM Care & Research, 48033 Cotignola, Ravenna, Italy.
Background:
The benefits of mitral repair versus replacement for endocarditis are inconclusive. This study compares outcomes of patients with infective endocarditis undergoing mitral valve repair versus replacement and investigates the impact of microbial etiology.
Methods:
All 251 patients undergoing mitral valve surgery for active endocarditis between 2010 and 2023 were enrolled, 180 (71.7%) replacement and 71 (28.3%) repair. To adjust for imbalances, inverse probability of treatment weighting was applied and 187 patients were obtained.
Results:
The analysis between groups, following the application of inverse probability of treatment weighting, showed no statistically significant differences across all considered outcomes. Early and late death was observed respectively in 6 (8.5%) and 11 (15.5%) patients in the repair group versus 24 (13.3%) and 45 (25.0%) in the replacement group without statistical significance (p = 0.221 and p = 0.446). Relapse occurred in six patients (8.5%) in the repair group after a median time of 4.0 months and in six (3.3%) in the replacement after 6.9 months (p = 0.071).
Conclusions:
Surgical strategy in mitral endocarditis has no effect on major postoperative complications, mortality, or medium/long-term survival. Staphylococcus aureus and Coagulase-negative Staphylococci represent a risk for early mortality and relapse. However, mitral valve repair for endocarditis can be pursued when it ensures the complete eradication of all infected tissue, particularly in cases caused by Streptococcus infection, in young patients, and after a minimum of 18 days of antibiotic therapy.
Insights
Mitral valve repair versus replacement for endocarditis shows similar outcomes. Surgical strategy does not impact complications or survival, but specific bacteria pose risks. Repair is viable with complete infection eradication.
Area of Science:
- Cardiovascular Surgery
- Infective Endocarditis Research
- Valvular Heart Disease
Background:
- Outcomes of mitral valve repair versus replacement for infective endocarditis remain unclear.
- This study compares patient outcomes and investigates microbial etiology's impact.
- Active endocarditis necessitates surgical intervention, but optimal valve strategy is debated.
Purpose of the Study:
- To compare the clinical outcomes of mitral valve repair versus replacement in patients with active endocarditis.
- To investigate the influence of microbial etiology on the success of surgical strategies.
- To evaluate the impact of surgical approach on mortality, complications, and long-term survival.
Main Methods:
- Retrospective analysis of 251 patients undergoing mitral valve surgery for active endocarditis (2010-2023).
- Patients were divided into mitral valve repair (71) and replacement (180) groups.
- Inverse probability of treatment weighting (IPTW) was used to adjust for baseline imbalances, resulting in 187 weighted patients for analysis.
Main Results:
- No statistically significant differences were observed between repair and replacement groups for early/late mortality or relapse rates post-IPTW.
- Early mortality: 8.5% (repair) vs. 13.3% (replacement); Late mortality: 15.5% (repair) vs. 25.0% (replacement) (p > 0.05).
- Relapse rates were similar (8.5% repair vs. 3.3% replacement), with median times of 4.0 and 6.9 months, respectively (p = 0.071).
Conclusions:
- Surgical strategy (repair vs. replacement) for mitral endocarditis does not significantly affect major postoperative complications, mortality, or medium/long-term survival.
- Staphylococcus aureus and Coagulase-negative Staphylococci are identified as risk factors for early mortality and relapse.
- Mitral valve repair is a viable option in endocarditis when complete infection eradication is achieved, especially for Streptococcus infections, in younger patients, and after adequate antibiotic therapy (≥18 days).
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