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[Reparative surgery of the mitral valve in bacterial endocarditis]
1II Divisione di Cardiochirurgia, Spedali Civili e Università degli Studi di Brescia.
Introduction:
Short and long-term results of valve repair for pure mitral insufficiency resulting from native valve endocarditis are reported in 28 consecutive patients with a mean age of 55 years (range 18-74).
Methods:
Six patients had acute endocarditis, with positive blood cultures in three of them. The mean time between onset of endocarditis symptoms and operation was 23 days in patients with acute endocarditis and 4.6 years in patients with healed endocarditis. Preoperatively, 87% of the patients were in NYHA class III. Indications for operation were heart failure (24 patients) and uncontrolled sepsis (4 patients). Mitral valvuloplasty was combined with other procedures in 4 patients. There was previous underlying valve pathology in 75%.
Results:
Mitral repair was performed according to the techniques proposed by Carpentier; in 2 cases we used an original technique consisting of a double-orifice repair. Only one patient died in the hospital (operative mortality: 3.5%). By actuarial methods 96% of the patients were alive 6 years postoperatively. During the follow-up period there was no recurrence of endocarditis and no reoperation for valvular insufficiency. Ninety-three per cent of the patients were in NYHA class I or II.
Conclusions:
We conclude that mitral valve repair for insufficiency resulting from bacterial endocarditis is possible in acute and healed disease, has a low operative mortality and has resulted in patients free of recurrent infection. Mitral valve repair is an attractive alternate to valve replacement in bacterial endocarditis.
Insights
Mitral valve repair is effective for bacterial endocarditis, showing low operative mortality and excellent long-term survival. This procedure offers a viable alternative to valve replacement, preventing recurrent infections.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Valvular Heart Disease
Context:
- Native valve endocarditis frequently causes pure mitral insufficiency.
- Surgical intervention is often necessary for patients with severe symptoms or complications.
- Previous valve pathology is common in patients undergoing mitral valve surgery for endocarditis.
Purpose:
- To evaluate the short- and long-term outcomes of mitral valve repair in patients with pure mitral insufficiency secondary to native valve endocarditis.
- To assess the feasibility and efficacy of mitral valve repair in both acute and healed stages of endocarditis.
Summary:
- This study reports on 28 patients who underwent mitral valve repair for endocarditis-related insufficiency, with a mean age of 55.
- Operative mortality was low (3.5%), with 96% survival at 6 years.
- No patients experienced recurrent endocarditis or required reoperation for mitral insufficiency, with 93% improving to NYHA class I or II.
Impact:
- Mitral valve repair demonstrates a low operative mortality and excellent long-term results for endocarditis-induced mitral insufficiency.
- The findings suggest mitral valve repair is a safe and effective alternative to valve replacement in this patient population.
- Successful repair leads to significant functional improvement and freedom from recurrent infection.