The advantage of repair of mitral valve in acute endocarditis

Leonid Sternik, Kenton J. Zehr, Thomas A. Orszulak, Charles J. Mullany, Richard C. Daly, Hartzell V. Schaff

Research output: Contribution to journalArticlepeer-review

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.

Original languageEnglish (US)
Pages (from-to)91-98
Number of pages8
JournalJournal of Heart Valve Disease
Volume11
Issue number1
StatePublished - Jan 1 2002

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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