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Is there an advantage to repairing infected mitral valves?
D D Muehrcke1, D M Cosgrove, B W Lytle
1Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio, USA.
Background:
The therapy for native mitral valve endocarditis is in evolution. Antibiotics have significantly improved survival rates, but patients with complications of endocarditis may require surgical treatment.
Methods:
Between January 1985 and December 1995, 146 patients underwent surgical therapy (repair or replacement) for native mitral valve endocarditis. All patients had documented bacterial endocarditis. Univariate and multivariate analyses were performed to determine predictors of hospital death, long-term event-free survival, and probability of repair. Patients were evaluated in three groups: all patients, patients with acute endocarditis, and patients with chronic endocarditis.
Results:
There were ten hospital deaths (6.8%). Patients undergoing repair had a lower hospital mortality rate (p = 0.008) then those having replacement. Event-free survival was improved after mitral valve repair in the overall group (p = 0.02) and in the group with healed (chronic) endocarditis (p = 0.05). Although the acute endocarditis group demonstrated an improved event-free survival rate after mitral valve repair versus replacement (74% versus 20% at 6 years), this did not reach statistical significance.
Conclusions:
We conclude that mitral valve repair is preferable to mitral valve replacement when possible, in patients with complications of endocarditis, as repair results in a lower hospital mortality and an improved long-term survival.
Insights
Mitral valve repair is preferable to replacement for native mitral valve endocarditis complications, offering lower hospital mortality and improved long-term survival. This surgical approach enhances event-free survival, particularly in chronic cases.
Area of Science:
- Cardiology
- Cardiac Surgery
- Infectious Diseases
Background:
- Native mitral valve endocarditis therapy is evolving.
- While antibiotics improve survival, surgical intervention is necessary for complications.
- Surgical options include mitral valve repair or replacement.
Purpose of the Study:
- To compare the outcomes of mitral valve repair versus replacement in patients with native mitral valve endocarditis.
- To identify predictors of hospital death, long-term survival, and repair probability.
- To evaluate outcomes in acute and chronic endocarditis patient groups.
Main Methods:
- A retrospective analysis of 146 patients who underwent surgical therapy for native mitral valve endocarditis between 1985 and 1995.
- Patients were categorized into three groups: all patients, acute endocarditis, and chronic endocarditis.
- Univariate and multivariate analyses were used to assess outcomes.
Main Results:
- Hospital mortality was 6.8% (10 deaths).
- Mitral valve repair was associated with significantly lower hospital mortality compared to replacement (p = 0.008).
- Event-free survival was improved with repair in the overall and chronic endocarditis groups (p = 0.02 and p = 0.05, respectively).
Conclusions:
- Mitral valve repair is the preferred surgical option for native mitral valve endocarditis with complications when feasible.
- Repair leads to reduced hospital mortality and enhanced long-term event-free survival.
- While not statistically significant, repair showed a trend towards better survival in acute endocarditis.