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Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable?

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Solari, Silvia [UCL] de Kerchove, Laurent [UCL] Tamer, Saadallah [UCL] Aphram, Gaby [UCL] Baert, Jerome [UCL] Borsellino, Stefano [UCL] Mastrobuoni, Stefano [UCL] Navarra, Emiliano [UCL] Noirhomme, Philippe [UCL] Astarci, Parla [UCL] Rubay, Jean [UCL] El Khoury, Gebrine [UCL]

(eng) OBJECTIVES: We retrospectively analysed our 20-year experience on surgical treatment of native mitral valve (MV) endocarditis in a single institution using an early and repair-oriented surgical approach. METHODS: From August 1991 to December 2015, 192 consecutive patients underwent MV surgery for active endocarditis. Of these, 81% (n = 155) had MV repair while 19% had MV replacement. In-hospital and late outcomes were analysed in the 2 groups and in the subgroups of repair with and without the use of a patch. Study end points were overall survival, MV reoperation and valve-related events. The median follow-up was 122 and 146 months in the repair and replacement groups, respectively. RESULTS: Patients undergoing MV replacement were significantly older with more severe preoperative comorbidities and clinical conditions compared to patients undergoing MV repair (P < 0.05). When the repair and replacement groups were compared, hospital mortality was 11.6% and 29.7%, respectively (P = 0.006); at 15 years, overall survival was 57 ± 6% and 36 ± 12%, respectively (P = 0.03); freedom from MV reoperation was 81 ± 6% and 73 ± 18%, respectively (P = 0.46); linearized rate of recurrent endocarditis was 0.1% and 2.4%, respectively. Fifteen-year freedom from reoperation was 75.4 ± 8.6% vs 92 ± 4.5% in the patch versus no-patch repair subgroups, respectively (P = 0.33). CONCLUSIONS: Active MV endocarditis remains a life-threatening disease. In experienced centres, an early and repair-oriented surgical approach can achieve relatively high reparability rates with good long-term durability of the repair and a very low recurrence rate of endocarditis. Patients could benefit from MV repair even if patch material is necessary to repair the valve.

Document type Article de périodique (Journal article) – Article de recherche
Access type Accès libre
Publication date 2019
Language Anglais
Journal information "European journal of cardio-thoracic surgery" - Vol. 55, no. 2, p. 256-262 (2019)
Peer reviewed yes
Publisher Oxford University Press ((United Kingdom) Oxford)
issn 1010-7940
e-issn 1873-734X
Publication status Publié
Affiliations UCL - (SLuc) Service de chirurgie cardiovasculaire et thoracique
UCL - SSS/IREC/CARD - Pôle de recherche cardiovasculaire
Keywords Valve disease ; Mitral valve repair ; Mitral valve replacement ; Endocarditis ; Patch repair
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Bibliographic reference Solari, Silvia ; de Kerchove, Laurent ; Tamer, Saadallah ; Aphram, Gaby ; Baert, Jerome ; et. al. Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable?. In: European journal of cardio-thoracic surgery, Vol. 55, no. 2, p. 256-262 (2019)
Permanent URL http://hdl.handle.net/2078.1/202973