Mitral valve reconstruction for active and healed endocarditis

Abstract

Background: Mitral valve reconstruction rather than replacement for mitral insufficiency offers a number of well-accepted benefits. However, the feasibility and results of reconstruction for endocarditis remain largely unknown.

Methods and results: We reviewed 22 consecutive patients referred to the Thoracic Surgical Service at the University of Michigan from January 1, 1991, through October 1, 1995, who underwent mitral valve reconstruction for mitral insufficiency caused by isolated mitral valve endocarditis. Mean age, preoperative ejection fraction, and New York Heart Association (NYHA) functional class were 53 +/- 15 years, 54 +/- 12%, and 3.2 +/- 0.8, respectively. Seven patients had early operation because of septic embolization, persistent infection, or refractory heart failure. Fifteen were cured of infection and were operated on for progressive symptomatic heart failure and left ventricular dilation. Preoperative transesophageal echocardiograms demonstrated severe mitral insufficiency in 20 patients. Valvular pathology noted at operation included annular (6 patients) or leaflet calcification (2), chordal rupture (13), leaflet vegetations (11), annular abscess (3), annular dilation (18), flail leaflet (12), leaflet prolapse (17), chordal shortening (1), and mitral stenosis (1). Mitral valve reconstruction included debridement of infected tissue and implantation of an annuloplasty ring (20 of 22 patients), as well as other complex techniques. Postrepair transesophageal echocardiograms demonstrated mild mitral insufficiency in 6 patients and none in 16 patients. There were no operative or in hospital deaths. Mean follow-up was 20 +/- 14 months. One late death occurred at 30 months. At follow-up, 90% of surviving patients were in NYHA functional class I or II.

Conclusions: Mitral valve reconstruction for active or healed endocarditis can be performed with low operative morbidity and mortality and yields excellent functional results. Although longer-term follow-up is mandatory, these data support strong consideration of mitral valve reconstruction rather than mitral valve replacement for mitral insufficiency secondary to endocarditis.