TY - JOUR
T1 - Early and late results of surgical treatment for isolated active native mitral valve infective endocarditis
AU - Tomšič, Anton
AU - Versteegh, Michel I. M.
AU - Ajmone Marsan, Nina
AU - van Brakel, Thomas J.
AU - Klautz, Robert J. M.
AU - Palmen, Meindert
PY - 2018
Y1 - 2018
N2 - OBJECTIVES: Native mitral valve infective endocarditis (IE) is a complicated disease with high mortality and morbidity rates. Mitral valve repair (MVRep) is feasible when limited valve destruction is present. However, recurrent valve dysfunction and reintervention are common. METHODS: Between January 2000 and March 2016, 83 patients underwent surgery for isolated active native mitral valve IE. We applied an early surgery, MVRep-oriented approach with progressive utilization of patch techniques to secure a durable repair; MVRep was attempted in 67% of patients. Fifty-one (61%) patients underwent MVRep (including full-ring annuloplasty in 94%) and 32 (39%) patients underwent mitral valve replacement. RESULTS: Early mortality was 13%. No cases of early recurrent IE occurred. Predischarge echocardiography demonstrated good MVRep function in all, except 1 patient with residual (Grade 2+) regurgitation. The mean duration of follow-up was 3.7 years (interquartile range 1.58.4). For hospital survivors, 8-year overall survival rates were 92.4% (95% confidence interval 84.0100%) and 74.2% (95% confidence interval 53.894.6%) for the MVRep and mitral valve replacement groups, respectively. Propensity score-adjusted Cox regression analysis revealed no significant difference in survival between the 2 groups (hazard ratio 0.359, 95% confidence interval 0.1071.200; P = 0.096). Four reinterventions occurred, 2 in each group. Echocardiographic follow-up demonstrated excellent MVRep durability; no cases of mitral regurgitation and 1 case of mitral valve stenosis were seen. CONCLUSIONS: Native mitral valve IE is linked to high mortality and morbidity rates. A durable MVRep is feasible in most patients and provides excellent mid-term durability. Mitral valve replacement is a reasonable alternative when a durable repair is not likely.
AB - OBJECTIVES: Native mitral valve infective endocarditis (IE) is a complicated disease with high mortality and morbidity rates. Mitral valve repair (MVRep) is feasible when limited valve destruction is present. However, recurrent valve dysfunction and reintervention are common. METHODS: Between January 2000 and March 2016, 83 patients underwent surgery for isolated active native mitral valve IE. We applied an early surgery, MVRep-oriented approach with progressive utilization of patch techniques to secure a durable repair; MVRep was attempted in 67% of patients. Fifty-one (61%) patients underwent MVRep (including full-ring annuloplasty in 94%) and 32 (39%) patients underwent mitral valve replacement. RESULTS: Early mortality was 13%. No cases of early recurrent IE occurred. Predischarge echocardiography demonstrated good MVRep function in all, except 1 patient with residual (Grade 2+) regurgitation. The mean duration of follow-up was 3.7 years (interquartile range 1.58.4). For hospital survivors, 8-year overall survival rates were 92.4% (95% confidence interval 84.0100%) and 74.2% (95% confidence interval 53.894.6%) for the MVRep and mitral valve replacement groups, respectively. Propensity score-adjusted Cox regression analysis revealed no significant difference in survival between the 2 groups (hazard ratio 0.359, 95% confidence interval 0.1071.200; P = 0.096). Four reinterventions occurred, 2 in each group. Echocardiographic follow-up demonstrated excellent MVRep durability; no cases of mitral regurgitation and 1 case of mitral valve stenosis were seen. CONCLUSIONS: Native mitral valve IE is linked to high mortality and morbidity rates. A durable MVRep is feasible in most patients and provides excellent mid-term durability. Mitral valve replacement is a reasonable alternative when a durable repair is not likely.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85044767024&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/29272376
U2 - https://doi.org/10.1093/icvts/ivx395
DO - https://doi.org/10.1093/icvts/ivx395
M3 - Article
C2 - 29272376
SN - 1569-9293
VL - 26
SP - 610
EP - 616
JO - Interactive cardiovascular and thoracic surgery
JF - Interactive cardiovascular and thoracic surgery
IS - 4
ER -