Tell it like it is: Experience in mitral valve surgery does matter for improved outcomes in mitral valve infective endocarditis

Infective endocarditis remains a dangerous condition and carries a mortality risk of approximately 20%. Splenic rupture is a rare complication of endocarditis. A 60-year-old woman with a history of atrial fibrillation, mitral valve repair and severe mitral regurgitation was admitted with a fall and abdominal pain. Emergency laparotomy was performed leading to a diagnosis of splenic rupture, for which splenectomy was performed. Four months later, the patient represented with symptoms of a transient ischaemic attack. Transthoracic and transoesophageal echocardiogram confirmed a large vegetation on the anterior mitral valve leaflet. Treatment with antibiotics and re-do mitral valve surgery was performed. The cause of the initial splenic rupture was felt to have been secondary to undiagnosed infective endocarditis. It is imperative to consider endocarditis in a case of spontaneous splenic rupture particularly in high-risk patients such as those with previous valve surgery.

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Aortic and mitral valve surgery for infective endocarditis with reconstruction of the intervalvular fibrous body: an analysis of clinical outcomes

Journal of Thoracic Disease ◽

10.21037/jtd.2020.03.04 ◽

2020 ◽

Vol 12 (4) ◽

pp. 1427-1436

Author(s):

Xuan Jiang ◽

Jinduo Liu ◽

Fareed Khan ◽

Rui Tang ◽

Yuhai Zhang ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Clinical Outcomes ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Fibrous Body

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Minimally Invasive Mitral Valve Surgery for Mitral Valve Infective Endocarditis

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0037-1604206 ◽

2017 ◽

Vol 66 (07) ◽

pp. 525-529 ◽

Cited By ~ 3

Author(s):

Joerg Seeburger ◽

Jens Garbade ◽

Uta Schon ◽

Martin Misfeld ◽

Friedrich Mohr ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Minimally Invasive ◽

Mitral Annulus ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Mitral Leaflet ◽

Minimally Invasive Approach ◽

Invasive Approach

Background The feasibility of minimally invasive mitral valve (MV) surgery in infective endocarditis (IE) has not been reported in detail. We assessed the safety, efficacy, and durability of the minimally invasive approach through a right anterolateral minithoracotomy for surgical treatment of MV IE. Methods A review of the Leipzig Heart Center database revealed 92 eligible patients operated on between 2002 and 2013. All patients had undergone minimally invasive surgery for IE. The indication for surgery was isolated IE of the MV in all patients. Baseline and intraoperative data, as well as clinical outcomes and short-term follow-up were analyzed retrospectively. Results The patients' mean age was 60.9 ± 15.3 years, the logistic EuroSCORE II was 19.6 ± 19.1%, and 64.1% (59) were male. MV repair was feasible in 23.9% (22/92) of patients. Repair techniques included annuloplasty ring implantation, anterior mitral leaflet resection, posterior mitral leaflet resection, and implantation of neochordae. MV replacement was performed in 69 patients (75%), a mitral annulus patch in 1 patient, and concomitant tricuspid valve surgery for tricuspid regurgitation in 5 patients. Bacteriological analysis showed staphylococcus infection in 45.5%, streptococcus in 36.4%, enterococcus in 13.6%, and others in 4.5%. The 30-day-mortality rate was 9.8% (9 patients). The 1-year follow-up showed a 1-year survival rate of 77.7 ± 4.4% and freedom from reoperation within 1 year due to reendocarditis of 93.3 ± 2.1%. Conclusions The minimally invasive approach is suitable for the treatment of IE of the MV. It is a good technique in IE in selected patients.

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Contemporary trends and outcomes of mitral valve surgery for infective endocarditis

Journal of Cardiac Surgery ◽

10.1111/jocs.14116 ◽

2019 ◽

Vol 34 (7) ◽

pp. 583-590

Author(s):

Mohamad Alkhouli ◽

Fahad Alqahtani ◽

Chalak Berzingi ◽

Chris C. Cook

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Surgery ◽

Valve Surgery

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Systematic Review of Minimally Invasive Surgery for Mitral Valve Infective Endocarditis

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery ◽

10.1177/1556984521997086 ◽

2021 ◽

pp. 155698452199708

Author(s):

Emily Shih ◽

John J. Squiers ◽

J. Michael DiMaio

Keyword(s):

Systematic Review ◽

Infective Endocarditis ◽

Mitral Valve ◽

Minimally Invasive ◽

Average Length ◽

Postoperative Bleeding ◽

Length Of Hospital Stay ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Perioperative Morbidity

Objective The scope of application of minimally invasive mitral valve surgery is expanding. However, the safety and efficacy of minimally invasive mitral valve surgery in the setting of infective endocarditis is not well known. We sought to identify the best evidence available to support a minimally invasive surgical approach for mitral valve infective endocarditis. Methods A systematic review of minimally invasive mitral valve surgery for infective endocarditis was conducted according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines. Results A total of 6 manuscripts describing 271 patients were identified. Mean age was 60.4 ± 14.9 years old, and 60.1% patients were male. Mean EuroSCORE II was 24.6 ± 23.2. Mitral valve repair was achieved in 32.4% of cases. The average in-hospital mortality was 9.4%, and average length of hospital stay was 21.6 days. Survival was 89.1% at 30 days, and 1-year survival was 79.3%. Rate of conversion to sternotomy was 1.8%. Postoperative complications included: 6.9% postoperative bleeding, 9.3% new postoperative dialysis, 2.3% postoperative stroke, and 3.4% recurrence of endocarditis. Reoperation over the long-term was required in 9.3% of cases. Conclusions Minimally invasive mitral valve surgery for infective endocarditis has acceptable perioperative morbidity as well as short- and intermediate-term mortality at experienced centers. Minimally invasive mitral valve surgery may be an acceptable alternative approach to infective endocarditis and warrants further study.

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Improved Outcomes of Re-Operative Mitral Valve Surgery Via Endoscopic, Right Mini-thoracotomy

Canadian Journal of Cardiology ◽

10.1016/j.cjca.2013.07.351 ◽

2013 ◽

Vol 29 (10) ◽

pp. S214-S215

Author(s):

K.L. Losenno ◽

S.A. Fox ◽

B. Kiaii ◽

M.W. Chu

Keyword(s):

Mitral Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Improved Outcomes ◽

Mini Thoracotomy

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Differences in mortality in patients undergoing surgery for infective endocarditis according to age and valvular surgery

BMC Infectious Diseases ◽

10.1186/s12879-020-05422-8 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Lauge Østergaard ◽

Morten Holdgaard Smerup ◽

Kasper Iversen ◽

Andreas Dalsgaard Jensen ◽

Anders Dahl ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Aortic Valve ◽

Surgical Intervention ◽

Prosthetic Heart Valve ◽

Mitral Valve Surgery ◽

Valve Surgery ◽

Aortic Valve Surgery ◽

Factors Associated ◽

Valvular Surgery

Abstract Background Infective endocarditis (IE) is associated with high mortality. Surgery may improve survival and reduce complications, but the balance between benefit and harm is difficult and may be closely related to age and type of surgical intervention. We aimed to examine how age and type of left-sided surgical intervention modified mortality in patients undergoing surgery for IE. Methods By crosslinking nationwide Danish registries we identified patients with first-time IE undergoing surgical treatment 2000–2017. Patients were grouped by age < 60 years, 60–75 years, and ≥ 75 years. Multivariable adjusted Cox proportional hazard analysis was used to examine factors associated with 90-day mortality. Results We included 1767 patients with IE undergoing surgery, 735 patients < 60 years (24.1% female), 766 patients 60–75 years (25.8% female), and 266 patients ≥75 years (36.1% female). The proportions of patients undergoing surgery were 35.3, 26.9, and 9.1% for patients < 60 years, 60–75 years, and > 75 years, respectively. Mortality at 90 days were 7.5, 13.9, and 22.3% (p < 0.001) for three age groups. In adjusted analyses, patients 60–75 years and patients ≥75 years were associated with a higher mortality, HR = 1.84 (95% CI: 1.48–2.29) and HR = 2.47 (95% CI: 1.88–3.24) as compared with patients < 60 years. Factors associated with 90-day mortality were: mitral valve surgery, a combination of mitral and aortic valve surgery as compared with isolated aortic valve surgery, age, diabetes, and prosthetic heart valve implantation prior to IE admission. Conclusions In patients undergoing surgery for IE, mortality increased significantly with age and 1 in 5 died above age 75 years. Mitral valve surgery as well as multiple valve interventions augmented mortality further.

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