Outcome after mitral valve repair for acute and healed infective endocarditis

Objective: To evaluate the long-term clinical and echocardiographic outcomes after mitral valve surgery for acute and healed infective endocarditis. Methods: Of 37 consecutive patients presenting with native mitral valve endocarditis, mitral valve repair (MVRep) was feasible in 34 (92%) patients. In 17 (50%) patients, surgery was indicated during antibiotic therapy (acute endocarditis), whereas 17 (50%) underwent surgery after antibiotic therapy was completed (healed endocarditis). Patients were evaluated for early and long-term clinical and echocardiographic outcome. Results: In-hospital death occurred in two (6%) patients and two (6%) died during follow-up, with a 2-year survival of 100% in healed endocarditis as compared to 76% (p = 0.03) in patients undergoing surgery in acute endocarditis. No patient with acute endocarditis needed repeat mitral valve surgery. Three (9%) patients underwent re-operation because of early mitral regurgitation (n = 1) or late recurrent endocarditis (n = 2). The average grade of mitral regurgitation was 3.8 ± 0.4 (all grades 3 to 4+) before surgery and 0.6 ± 0.8 during follow-up (p < 0.001). Significant reductions in left atrial (from 52 ± 8 mm to 46 ± 8 mm, p = 0.004), left ventricular end-diastolic (from 61 ± 8 mm to 54 ± 8 mm, p = 0.001), and end-systolic dimensions (from 41 ± 8 mm to 36 ± 9 mm, p = 0.02) were observed during follow-up, compared to preoperative dimensions. Of note, significant reverse remodeling was only observed in patients undergoing surgery in healed endocarditis. Conclusion: MVRep for mitral valve endocarditis is feasible with good clinical results, maintained valve competency with significant reductions in left atrial and left ventricular dimensions after surgery.