Extending the scope of mitral valve repair in active endocarditis

• Published in: The Journal of thoracic and cardiovascular surgery Vol. 143; no. 4; pp. S91 - S95
• Main Authors: de Kerchove, Laurent, MD, Price, Joel, MD, MPH, Tamer, Saadallah, MD, Glineur, David, MD, PhD, Momeni, Mona, MD, Noirhomme, Philippe, MD, ElKhoury, Gebrine, MD
• Format: Journal Article
• Language: English
• Published: New York, NY Mosby, Inc 01-04-2012; Elsevier
• Subjects: Adult; Aged; Aged, 80 and over; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy; Belgium; Biological and medical sciences; Cardiology. Vascular system; Cardiothoracic Surgery; Endocardial and cardiac valvular diseases; Endocarditis - mortality; Endocarditis - surgery; Female; Heart; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - mortality; Hospital Mortality; Humans; Kaplan-Meier Estimate; Male; Medical sciences; Middle Aged; Mitral Valve - surgery; Mitral Valve Annuloplasty - adverse effects; Mitral Valve Annuloplasty - mortality; Pneumology; Recurrence; Reoperation; Retrospective Studies; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome; Young Adult; Belgium; infective endocarditis; MR; mitral regurgitation; MV; mitral valve; 35.4.1; IE; 35.4; Mitral valve; Cardiac valvular disease; Endocardial disease; Endocarditis; Cardiovascular disease; Anesthesia; Circulatory system; Cardiology; Mitral valve disease
• ISSN: 0022-5223; 1097-685X
• DOI: 10.1016/j.jtcvs.2012.01.049

Objective During the last 2 decades, we have applied a repair-oriented surgical approach to patients with active mitral valve endocarditis. We retrospectively analyzed the long-term outcomes with this repair-oriented approach. Method Between 1991 and 2010, 137 patients underwent operation for active mitral valve endocarditis; of these, 109 patients (80%) had mitral valve repair and represent the study cohort. Repair techniques without patch extension (no-patch techniques) include triangular or quadrangular resection (n = 49), sliding plasty (n = 24), neochordae (n = 18), chordal transfer (n = 12), and others (n = 5). Repair techniques using patch extension (patch techniques) included pericardium (n = 42), tricuspid autograft (n = 8), flip-over technique (n = 7), and partial mitral valve homograft (n = 5). Patches were used in 67 patients (61%). Ring annuloplasty was performed in 60 patients, and a pericardial band was used in 13 patients. Clinical and echocardiographic follow-up were performed. Median follow-up was 48 months. Results Hospital mortality was 16%. At 8 years, overall survival was 62% ± 10% with no differences between patients with or without patch repair ( P = .5). Freedom from mitral valve repair failure was 81% ± 14% in patients with patch repair and 90% ± 10% in patients without patch repair ( P = .09). The rate of thromboembolic or bleeding event was 1% per patient-year, and the rate of endocarditis recurrence was 0.3% per patient-year. Univariable predictors of mortality were age more than 70 years ( P < .0001), perivalvular abscess ( P  = .002), diabetes mellitus ( P = .0002), and renal failure ( P = .04). Predictors of repair failure were renal failure ( P = .035) and perivalvular abscess ( P = .033). Conclusions In active mitral valve endocarditis, a repair-oriented surgical approach achieves a reparability rate of 80% with acceptable morbidity and good long-term results. The use of patch techniques offers a durability rate that approximates the rate obtained with the no-patch techniques.