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Longitudinal Outcomes of Mitral Valve Surgery for Infective Endocarditis Within a Repair-First Strategy

Hakam Rajjoub1, Stanley B Wolfe1, Lawrence Wei1

  • 1Department of Cardiovascular and Thoracic Surgery, West Virginia University, Morgantown, West Virginia.

The Annals of Thoracic Surgery
|July 30, 2026
PubMed
Abstract

Insights

Mitral valve repair in infective endocarditis offers better survival and fewer complications than replacement. A repair-first strategy is safe and effective for improving patient outcomes.

Area of Science:

  • Cardiovascular Surgery
  • Infective Endocarditis
  • Mitral Valve Disease

Background:

  • Mitral valve (MV) infective endocarditis (IE) often requires surgery for severe mitral regurgitation.
  • The long-term effects of MV surgery using a repair-first approach are not well understood.

Purpose of the Study:

  • To evaluate the outcomes of mitral valve surgery in patients with acute infective endocarditis.
  • To compare the results of mitral valve repair versus replacement within a repair-first strategy.

Main Methods:

  • A retrospective analysis of 198 patients undergoing MV surgery for IE between 2016 and 2024.
  • Patients were managed with a repair-first strategy; replacement was used when repair was not feasible.
  • Primary outcomes included survival and a composite of reinfection, reoperation, or death.

Main Results:

  • 102 patients (51.5%) underwent repair and 96 (48.5%) underwent replacement.
  • The repair group had significantly better survival (HR 0.49, p=0.01) and freedom from composite outcomes (HR 0.27, p<0.0001).
  • Repair was associated with shorter ICU stays and less prolonged ventilation.

Conclusions:

  • Complex mitral valve repair in acute IE is safe and durable.
  • A repair-first strategy leads to favorable perioperative recovery and improved mid-term outcomes.
  • These findings support a repair-first approach for MV intervention in IE when feasible.

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