The advantage of repair of mitral valve in acute endocarditis

Abstract

Background and aim of the study: Mitral valve repair offers a survival benefit compared with valve replacement in surgery for non-infectious mitral regurgitation. It is unclear whether repair offers an advantage for patients undergoing mitral valve surgery for active endocarditis. Morbidity and mortality (early and late) and event-free survival were compared between the repair and replacement groups.

Methods: Between September 1986 and July 1999, 44 patients with acute native mitral valve endocarditis underwent surgery; 28 patients had valve replacement, and 16 underwent repair. Nine patients had complex repairs including replacement of a portion of the leaflet with prosthetic patch, placement of artificial chordae, resection of a portion of both leaflets, and/or reconstruction of a commissure. The remainder had simple repairs.

Results: Preoperative characteristics and indications for surgery between the two groups were similar. There were six in-hospital (21%) and six late cardiac deaths (21%) in the valve replacement group, but no early deaths or late cardiac deaths in the repair group (p <0.05). Independent risk factors for early and late death were need for associated procedures (p <0.03) and mitral valve replacement (p <0.05). Additional risk factors for late death were diabetes mellitus (p = 0.005) and hemodynamic instability as an indication for surgery (p = 0.047). Five patients undergoing valve replacement required reoperation due to recurrent endocarditis, compared with none in the repair group (p = 0.065). Mean follow up was 39+/-33 months in the repair group, and 57+/-51 months in the replacement group.

Conclusion: Early and late mortality and event-free survival were better in patients undergoing mitral valve repair compared with replacement for acute endocarditis. Valve repair should be carried out whenever possible in this patient group.