Long-Term Outcomes of Mitral Valve Repair for Active Endocarditis

Kanemitsu, Hideo; Nakamura, Ken; Fukunaga, Naoto; Koyama, Tadaaki

doi:10.1253/circj.cj-15-1062

Cited by 14 publications

(11 citation statements)

References 24 publications

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“…Streptococci were the more frequent etiologic agents (50%) in our study, in agreement with previous investigations [16, 18]. It is conceivable that a more limited damage to valve structure related to the lower virulence of streptococcal infection allowed more frequently to perform MV repair.…”

Section: Discussionsupporting

confidence: 92%

“…In present study in hospital mortality was 11%, similar to that reported in previous studies (8–12%). Long term survival of discharged patients, 96.7%, is similar to that reported by Kanemitsu [18] and higher than in other studies [11, 17]. All patients showed a significant improvement in functional capacity.…”

Section: Discussionsupporting

confidence: 87%

“…At 1 year actuarial event-free survival was 88.2% in the repair group compared with 67.7% in the replacement group. In the study by Kanemitsu et al [18] 43 patients who underwent primary MV repair for IE at a single center between 1991 and 2009 were retrospectively examined. Survival was 92.6 ± 4.1% at 5 years.…”

Section: Discussionmentioning

confidence: 99%

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Role of mitral valve repair in active infective endocarditis: long term results

Rostagno

Carone

Stefàno

2017

J Cardiothorac Surg

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BackgroundAlthough mitral valve repair is at present the technique of choice in mitral regurgitation (MR) due to degenerative valve disease, long term results in patients with active mitral infective endocarditis (IE) are still under evaluation.MethodsIn the study were included 34 consecutive patients (22 males; mean age, 60 years; range 32–84 years) referred to our institution between January 1, 2005 to December 31, 2011 who were treated with valve repair for mitral valve (MV) active infective endocarditis. Eighteen patients underwent isolated MV repair. Aortic valve replacement and respectively repair were performed in 9 and 2 patients with concomitant aortic involvement. Blood cultures were positive in 30 (17 Staphylococcus, 13 Streptococcus, 1 g negative, 2 enterococcus).ResultsFour patients died during hospital stay (11%) due to multi system organ failure as a consequence of severe septic shock (2 patients), cardiogenic shock (1 case) and respiratory failure (1 patient). At an average follow up of 48 months in patients discharged alive from hospital survival was 96.7% (29 out of 30). None developed more than mild- to moderate mitral valve regurgitation during follow-up and we found a significant improvement in functional capacity and left ventricular ejection fraction associated with a significant decrease of pulmonary artery pressure. The only recurrence of endocarditis occurred in a drug addict patient.ConclusionsPresent investigation suggest that in patients with active mitral valve endocarditis MV repair, when technically feasible, is associated with a favorable clinical long term outcome. None of the patients alive at the end of follow-up developed severe mitral regurgitation. Moreover mortality and reinfection rate are uncommon and functional improvement.

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Section: Discussionsupporting

confidence: 92%

Section: Discussionsupporting

confidence: 87%

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Role of mitral valve repair in active infective endocarditis: long term results

Rostagno

Carone

Stefàno

2017

J Cardiothorac Surg

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“…It has also been suggested that very ES would prevent embolic strokes. 12,16,17 In our study, the frequency of postoperative strokes was higher in the ES group. Unfortunately, all of the patients had not undergone brain imaging studies preoperatively, and therefore the reported rates of preoperative embolic strokes might not be completely reliable.…”

Section: Discussionsupporting

confidence: 46%

“…In the present study, the patient characteristics differed from the EASE study, and most patients with an indication for emergent or urgent surgery were operated within 1 week of prior directed antimicrobial treatment. It has also been suggested that very ES would prevent embolic strokes . In our study, the frequency of postoperative strokes was higher in the ES group.…”

Section: Discussionmentioning

confidence: 99%

Outcome of early vs delayed surgery for infective mitral endocarditis

2019

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Background and aim of the study Timing of surgery for infective endocarditis is controversial. The objective of this study was to report the outcomes of early vs delayed surgery (DS) of mitral endocarditis. Methods We retrospectively reviewed all patients treated surgically for mitral endocarditis between 2005 and 2016 in a single center. We analyzed midterm outcomes of early surgery (ES; surgery within 7 days or less of prior directed antibiotic treatment) in comparison to DS (surgery after more than 7 days of prior directed antibiotic treatment). Results Survival of all patients was 87% at one and 72% at 5 years. Mean follow‐up time was 4.0 ± 3.1 years. Thirty‐three (36.3%) patients were in the ES and 58 (63.7%) were in the DS group. Patients with ES were younger (47.4 vs 55.3 years), were in New York Heart Association class III or IV more frequently (97.0 vs 65.5%), and had higher EuroScore2 (15.6 vs 8.6%). The ES group had lower freedom from valve reoperation (98.2 vs 87.2%; P = .035) and the composite endpoint of >2 + regurgitation or reoperation at 5 years (98.2 vs 72.7%; P = .004). Conclusions ES was associated with a higher rate of reoperations and the composite endpoint of recurrent MR or reoperation.

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Repair of infected mitral valves: what have we learned?

Wan

2018

Surg Today

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Infective endocarditis (IE) is associated with high mortality and morbidity and requires surgical intervention in about half of all patients. Mitral valve repair (MVrep) is reported to achieve better results than mitral valve replacement because the insertion of a prosthesis during active infection is avoided. However, MVrep in active IE is complicated and no definitive guidelines have been compiled. The current study reviews the literature from 2000 to 2016 and summarizes the surgical details of MVrep for IE.

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Long-Term Outcomes of Mitral Valve Repair for Active Endocarditis

Cited by 14 publications

References 24 publications

Role of mitral valve repair in active infective endocarditis: long term results

Role of mitral valve repair in active infective endocarditis: long term results

Outcome of early vs delayed surgery for infective mitral endocarditis

Repair of infected mitral valves: what have we learned?

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