“Splint” Mitral Valve Repair for Destructive Endocarditis in Children

Medical management of infective endocarditis in the pediatric population has an associated in-hospital mortality rate of up to 25%. In the past, infective endocarditis of the mitral valve was surgically managed with a valve replacement. Now, there is a shift toward repair. However, for complex lesions in pediatric patients, many institutions are still hesitant to perform a mitral valve repair. We describe the cases of three children with destructive mitral valve endocarditis and risk factors for higher perioperative mortality and morbidity who were successfully treated with a complex mitral valve repair with “splint” patch plasty of the posteromedial commissure.

Download Full-text

Mitral valve repair: Infective endocarditis after MitralClip

The Thoracic and Cardiovascular Surgeon ◽

10.1055/s-0032-1332630 ◽

2013 ◽

Vol 61 (S 01) ◽

Cited By ~ 2

Author(s):

D Maznikoski ◽

K Denk ◽

I Karliova ◽

CF Vahl

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

Download Full-text

Heart transplantation and mitral valve repair in pediatric patients with refractory heart failure

Transplantation Proceedings ◽

10.1016/s0041-1345(02)03985-4 ◽

2003 ◽

Vol 35 (1) ◽

pp. 463-465 ◽

Cited By ~ 4

Author(s):

S.-S Wang ◽

R.-B Hsu ◽

Y.-S Chen ◽

W.-J Ko ◽

N.-K Chou ◽

...

Keyword(s):

Heart Failure ◽

Mitral Valve ◽

Heart Transplantation ◽

Mitral Valve Repair ◽

Pediatric Patients ◽

Valve Repair ◽

Refractory Heart Failure

Download Full-text

Mitral valve repair versus replacement for infective endocarditis, again

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2019.02.044 ◽

2019 ◽

Vol 158 (2) ◽

pp. e33-e34

Author(s):

Manuel J. Antunes

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

Download Full-text

Corrigendum to: Outcomes of mitral valve repair in acute native mitral valve infective endocarditis [Interact CardioVasc Thorac Surg 2019; doi:10.1093/icvts/ivz187]

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz228 ◽

2019 ◽

Vol 29 (5) ◽

pp. 820-820

Author(s):

Mohamed El Gabry ◽

Zaki Haidari ◽

Fanar Mourad ◽

Janine Nowak ◽

Konstantinos Tsagakis ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair

Download Full-text

Active infective endocarditis after mitral valve repair

General Thoracic and Cardiovascular Surgery ◽

10.1007/s11748-009-0479-0 ◽

2010 ◽

Vol 58 (1) ◽

pp. 49-52

Author(s):

Takashi Miura ◽

Kiyoyuki Eishi ◽

Koji Hashizume ◽

Shinichiro Taniguchi ◽

Kazuyoshi Tanigawa ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Valve Repair ◽

Active Infective Endocarditis

Download Full-text

Outcomes of mitral valve repair in acute native mitral valve infective endocarditis

Interactive CardioVascular and Thoracic Surgery ◽

10.1093/icvts/ivz187 ◽

2019 ◽

Vol 29 (6) ◽

pp. 823-829 ◽

Cited By ~ 3

Author(s):

Mohamed El Gabry ◽

Zaki Haidari ◽

Fanar Mourad ◽

Janine Nowak ◽

Konstantinos Tsagakis ◽

...

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Limited Resection ◽

Long Term Results ◽

Valve Repair ◽

Direct Closure ◽

Complex Procedure ◽

Hospital Stays

AbstractOBJECTIVESMitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis.METHODSBetween January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events.RESULTSThe mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively.CONCLUSIONSAlthough MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.

Download Full-text

Mitral valve repair for infective endocarditis: Kobe experience

Asian Cardiovascular and Thoracic Annals ◽

10.1177/0218492320947586 ◽

2020 ◽

Vol 28 (7) ◽

pp. 384-389

Author(s):

Yukikatsu Okada ◽

Takeo Nakai ◽

Takashi Muro ◽

Hisato Ito ◽

Yu Shomura

Keyword(s):

Infective Endocarditis ◽

Mitral Valve ◽

Mitral Valve Repair ◽

Event Free Survival ◽

Valve Repair ◽

Free Survival ◽

Autologous Pericardium ◽

Ring Annuloplasty ◽

Group A ◽

Group B

Objectives We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution. Methods From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months. Results There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups ( p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B ( p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010). Conclusions Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

Download Full-text