Long-term outcome of extensive mitral valve reconstruction with autologous pericardium and artificial chordae for treatment of destructive active infective endocarditis of the mitral valve

Abstract

Objective Mitral valve (MV) repair is a well-accepted surgical approach for infective endocarditis (IE). In our hospital, extensive MV reconstruction with fresh autologous pericardium (AP) and artificial chordae (AC) has been performed for patients with profoundly extensive and destructive IE in which valve reconstruction would be extremely challenging, especially in young patients to avoid mechanical valve replacement. Long-term outcome including the future performance of the newly created leaflet has not been established. Methods Five patients (54 (38–60) years of age; 3 men, 2 women) underwent this procedure from January 2011 to April 2022. In all patients, preoperative cardiac function was good (left ventricular ejection fraction, 69 (66–75)). After complete debridement of the infective valve tissue, the MV was reconstructed with large, fresh, trimmed AP and AC. Results The reconstructed leaflets were anterior in three patients and posterior in four, and AC were placed in four patients. All patients showed an uneventful postoperative course and were discharged to home 36 (28–42) days postoperatively after completion of intravenous antibiotic therapy. Pre-discharge echocardiography revealed no or trivial mitral regurgitation (MR) in all patients. The median follow-up period was 9.6 (6.0–10.4) years, and no patients developed recurrence of the IE. The latest echocardiography in four patients showed trivial/mild MR with good leaflet function. One patient developed recurrence of MR, 5 months postoperatively. Conclusions The short- and long-term outcomes of this procedure might be acceptable. This procedure might be considered as an effective and valuable option, especially in young patients.

Posterior Mitral Leaflet (PML) Perforation due to Infective Endocarditis (IE) Complicated with Cerebral Infarction

“…Valve repair using autologous tissues, such as the pericardium, is the most desirable procedure. Previous studies have reported the use of autologous pericardium to repair valves [ 3 , 4 ]. Although autologous tissue is a good option for compensating defective areas, its durability is a problem.…”

“…Surgeons usually have the following options: a fresh pericardium and a glutaraldehyde-treated pericardium. However, several controversies exist regarding shrinkage, calcification, and durability [ 3 , 5 ]. Shomura et al reported that the glutaraldehyde-treated autologous pericardium has good durability [ 8 ].…”