scholarly journals A structured approach to native mitral valve infective endocarditis: Is repair better than replacement?

2020 ◽  
Vol 58 (3) ◽  
pp. 544-550
Author(s):  
Rufin J Defauw ◽  
Anton Tomšič ◽  
Thomas J van Brakel ◽  
Nina Ajmone Marsan ◽  
Robert J M Klautz ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Complex Disease ◽  
Patch Repair ◽  
Early Surgery ◽  
Valve Repair ◽  
Post Surgery ◽  
Late Morbidity ◽  
Structured Approach

Abstract OBJECTIVES Mitral valve repair in native active infective endocarditis is technically challenging. The survival benefit over valve replacement is poorly established and possibly absent because of the high risk of repair failure and reoperation. In this study, we explore the results of our structured approach in these patients. METHODS Between January 2000 and January 2017, 149 patients underwent surgery for native mitral infective endocarditis. Among them, 97 (66%) patients underwent valve repair and 52 (34%) underwent valve replacement. Our structured approach consisted of early surgery, radical resection of infected tissue, liberal use of prosthetic materials and ‘patch’ repair techniques. A critical assessment of expected repair durability was made intraoperatively and repair was not performed if concerns of long-term durability existed. To study the effects of valve repair on overall survival, landmark analysis was performed. RESULTS In-hospital mortality was 15.4% (14 repair vs 9 replacement patients; P = 0.642). There were no residual infective endocarditis cases or early reoperations. On Cox proportional hazards analysis, valve replacement was not inferior to repair within 1-year post-surgery [hazard ratio (HR) 1.134, 95% confidence interval (CI) 0.504–2.540; P = 0.76]. Beyond 1 year post-surgery, replacement was associated with decreased survival (HR 2.534, 95% CI 1.002–6.406; P = 0.049). There were no differences in freedom from recurrent infective endocarditis (P = 0.47) and mitral valve reintervention (P = 0.52). CONCLUSIONS Active mitral valve endocarditis remains a complex disease with significant early and late morbidity and mortality. A structured approach allows valve repair in two-thirds of patients. Clinical results could be improved by focussing on early surgery, prior to extensive valve destruction, to enable durable repairs and improve late outcomes.

scholarly journals Feasibility and outcome of mitral valve repair in patients with infective endocarditis

2020 ◽  
Vol 28 (1) ◽  
Author(s):  
Valentina Scheggi ◽  
Iacopo Olivotto ◽  
Stefano Del Pace ◽  
Nicola Zoppetti ◽  
Alterini Brunetto ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Adverse Events ◽  
Valve Replacement ◽  
Systolic Function ◽  
Left Ventricular Systolic Function ◽  
Left Ventricular ◽  
Valve Repair ◽  
Ventricular Systolic Function

Abstract Background Valve repair is the treatment of choice for native mitral valve regurgitation. The feasibility of repair when the defect is caused by acute infective endocarditis (IE) is debated. This study aims to compare the outcome of repair and replacement procedures, to report the rate of repair in a single surgical center, and to review the literature on this topic. Results We retrospectively analyzed 108 patients with native mitral IE, potentially eligible for surgical repair. Of these 108, 90 (83%) underwent surgery, and 18 were treated conservatively. Among the 90 surgical patients, 57 (63%) underwent valve replacement and 33 valve repair (37%). The mean follow-up duration was 3 years. The two primary endpoints were mortality and freedom from recurrent endocarditis. Secondary endpoints were the post-operative incidence of major adverse events (hospitalization for any cause, pacemaker implantation, new onset of atrial fibrillation, sternal dehiscence), left ventricular systolic function (LVSF), and valvular function at 1-year echocardiographic follow-up. All-cause mortality was lower for valve repair, although not significantly (p = 0.86), as well as nonfatal adverse events (p = 0.92) and relapse rate (p = 0.20) at 3 years. We did not find differences between the two groups at echocardiographic follow-up, neither for left ventricular systolic function (p = 0.22), nor for valvular continence (p = 0.28). Conclusions In our experience, the mid-term outcome of repair in IE is comparable to valve replacement and should be considered whenever possible, as in degenerative valve disease. The review of the literature supports this strategy.

scholarly journals Infective endocarditis after mitral valve repair wherefore mitral valve replacement was preformed

2018 ◽  
Vol 13 (5-6) ◽  
pp. 189-189
Author(s):  
Vera Slatinski ◽  
Ante Pašalić ◽  
Marko Perčić ◽  
Zrinka Planinić ◽  
Edvard Galić
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Valve Repair

Infective endocarditis and outcomes of mitral valve replacement

2021 ◽  
Author(s):  
Vesa Anttila ◽  
Markus Malmberg ◽  
Jarmo Gunn ◽  
Päivi Rautava ◽  
Ville Kytö
Keyword(s):  
Infective Endocarditis ◽  
Mitral Valve ◽  
Valve Replacement ◽  
Mitral Valve Replacement

scholarly journals Mitral valve repair in heart failure: Five-year follow-up from the mitral valve replacement stratum of the Acorn randomized trial

2011 ◽  
Vol 142 (3) ◽  
pp. 569-574.e1 ◽  
Author(s):  
Michael A. Acker ◽  
Mariell Jessup ◽  
Steven F. Bolling ◽  
Jae Oh ◽  
Randall C. Starling ◽  
...  
Keyword(s):  
Heart Failure ◽  
Mitral Valve ◽  
Randomized Trial ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Valve Repair

Surgery for Degenerative Mitral Regurgitation Valve Repair v. Valve Replacement with Chordal Preservation

1994 ◽  
Vol 2 (2) ◽  
pp. 90-94
Author(s):  
Masaharu Shigenobu ◽  
Shunji Sano
Keyword(s):  
Mitral Valve ◽  
Mitral Regurgitation ◽  
Left Ventricular Function ◽  
Ventricular Function ◽  
Valve Replacement ◽  
Mitral Valve Replacement ◽  
Mitral Valve Repair ◽  
Left Ventricular ◽  
Valve Repair ◽  
Repair Group

This study compares mitral valve repair and mitral valve replacement with chordal preservation for chronic mitral regurgitation due to myxomatous degeneration with special reference to left ventricular function. Twenty-six patients underwent complete preoperative and 2 years later postoperative echocardiography study. Thirteen patients underwent mitral valve replacement associated with preservation of chordae tendineae and papillary muscles, and 13 patients had mitral valve repair. There were no statistically significant differences between the 2 groups for clinical findings, hemodynamic profiles, or left ventricular function compared prior to surgery. After correcting mitral regurgitation, increase in cardiac index was significant for the repair group. Left ventricular end-diastolic volume decreased in both groups. Left ventricular end-systolic volume significantly decreased in the repair group, but remained unchanged in the replacement group. Both ejection fraction and mean left ventricular circumferential fiber shortening velocity (mVcf) decreased in the replacement group, but significantly increased in the repair group 2 years after surgery. These findings suggest valve replacement with chordal preservation shows less improvement in ventricular systolic function late after surgery compared with mitral valve repair.

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