Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry

Cuerpo, Gregorio; Valerio, Maricela; Pedraz, Álvaro; Rodríguez‐Abella, Hugo; Mestres, Carlos A.; González-Calle, Antonio; Álvarez, Regino Rodríguez; Muñoz, Patricia; Bouza, Emilio

doi:10.1007/s11748-019-01063-0

Cited by 10 publications

(26 citation statements)

References 25 publications

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“…Second, when the comparative analysis of MV repair vs replacement was repeated stratifying patients into two groups based on the timing of surgery (within 7 days and >7 days), MV repair remained associated with lower incidence of in-hospital mortality and key postoperative morbidities although the magnitude of benefit was higher among those who underwent surgery within 7 days (Online Table 4). 4 Similar results were reported in other studies with smaller sample size. 5,8,14,16 Nonetheless, large-scale data on the utilization and outcomes of MV repair vs replacement in patients with IE are lacking.…”

Section: Sensitivity Analysis: Two Confirmatory Comparative Analysessupporting

confidence: 88%

Contemporary trends and outcomes of mitral valve surgery for infective endocarditis

Alkhouli

Alqahtani

Berzingi

et al. 2019

Journal of Cardiac Surgery

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Background Contemporary data on mitral valve (MV) surgery in patients with infective endocarditis (IE) are limited. Methods The National Inpatient Sample was queried to identify patients with IE who underwent MV surgery between 2003 and 2016. We assessed (a) temporal trends in the incidence of MV surgery for IE, (b) morbidity, mortality, and cost of MV repair vs replacement, and (c) predictors of in‐hospital mortality. Results The proportion of MV operations involving patients with IE increased from 5.4% in 2003 to 7.3%, and the proportion of MV repair among those undergoing surgery for IE increased from 15.2% to 25.0% (Ptrend < .001). In‐hospital mortality was higher in the replacement group (11.3% vs 8.1%; P < .001), and this excess mortality persisted after propensity score matching (11.2% vs 8.1%; P < .001), and in sensitivity analyses excluding concomitant surgery (unadjusted 11.3% vs 4.8%; adjusted 8.5% vs 4.5%; P < .001), and stratifying patients by the time of operation (within 7 days, 11.3% vs 6.8%; P < .001 and >7 days, 11.9% vs 9.1%; P = .012). In the propensity‐matched cohorts, shock and need for tracheostomy were more frequent in the replacement group, but rates of stroke, pacemaker implantation, new dialysis, and blood transfusion were similar. Mitral valve repair was, however, associated with shorter hospitalizations, more home discharges, and less cost. In a multivariate regression analysis, age above 70 and chronic dialysis were the strongest predictors of in‐hospital mortality. Conclusion Mitral valve repair in IE patients is associated with lower in‐hospital mortality, resource utilization, and cost compared with MV replacement.

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Section: Sensitivity Analysis: Two Confirmatory Comparative Analysessupporting

confidence: 88%

Contemporary trends and outcomes of mitral valve surgery for infective endocarditis

Alkhouli

Alqahtani

Berzingi

et al. 2019

Journal of Cardiac Surgery

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“…The search strategy revealed a total of 4794 relevant publications, with 17 studies 2,8–23 finally meeting the inclusion criteria. There were no relevant randomized controlled trials identified after researching the literature databases.…”

Section: Resultsmentioning

confidence: 99%

“…Eleven studies 2,10,11,13–18,20,21 were included (including 3170 patients stratified as 852 who received MVP and 2345 who received MVR). Forest plots (Figure 7) created using RevMan version 5.4 illustrated a distinct difference between the two groups (random‐effects model, HR, 0.69; 95% CI, 0.58–0.81; p < .001; I 2 = 0%).…”

Section: Resultsmentioning

confidence: 99%

Valve replacement or repair in native mitral valve infective endocarditis—Which is better? A meta‐analysis and systematic review

Song

Luo

et al. 2022

Journal of Cardiac Surgery

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Background Native mitral valve infective endocarditis (IE) plagues patients and surgeons alike because of its high mortality and recurrence rates as well as poor prognosis. Mitral valve repair (MVP) and mitral valve replacement (MVR) are two main surgical methods. However, the question of which benefits patients more remains controversial. Thus, we conducted a meta‐analysis to systematically review the two approaches, focusing on the early survival rate and long‐term outcomes. Methods A meta‐analysis and systematic review were conducted using studies sourced from the PubMed, Embase, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk ratio (RR) or hazard ratio (HR) values were calculated, and publication bias was tested. Results A total of 17 relevant publications with a total population of 3759 patients, with 1180 patients having undergone MVP and 2579 patients having undergone MVR, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR, 0.51; 95% confidence interval [CI], 0.39–0.66; p < .00001), a higher long‐term survival rate (HR, 0.69; 95% CI, 0.58–0.81; p < .001; I2 = 0%), and a lower risk of recurrence (RR, 0.66; 95% CI, 0.40–1.09; p = .10; I2 = 0%). However, a similar risk of reoperation was observed for both groups (RR, 1.02; 95% CI, 0.36–2.91; p = .96; I2 = 43%). Conclusion This meta‐analysis suggests that MVP may lead to better outcomes compared to MVR. Among patients with mitral valve IE, MVP can reduce in‐hospital mortality, improve long‐term survival, and has a lower risk of recurrent endocarditis. As a result, MVP may be suitable as a primary treatment choice and should be considered whenever possible in most IE patients.

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“…Solari et al [21] 155 Cuerpo et al [24] 68 ( Feringa et al [17] 490 (39%) 2.3% 14.2% 7.8% 3 y 40.5% 3 y Strept 43%-42% Staph 24%-31% Other 13%-7% Culture 20%-20% Negative…”

Section: 9%mentioning

confidence: 99%

“…However, the percentage of repair vs. replacement showed high variability in different centers. Overall MV repair is associated with a better outcome in comparison to valve replacement both in term of in-hospital and long-term mortality [19][20][21][22][23][24][25] . Furthermore, the risk of recurrence of endocarditis is significantly lower after MV repair.…”

Section: The Endocarditis Team -Rolementioning

confidence: 99%

Mitral valve repair in infective endocarditis: which evidence?

Rostagno¹

2020

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Infective endocarditis is still a challenging clinical condition undergoing continuous epidemiologic changes, involving both the population at risk and the microbiological etiology. Antibiotic treatment alone is not effective in presence of structural abnormalities of native valves, leading to heart failure and/or to high embolic risk. Moreover, some patients despite being treated with antibiotics, their valve leaflets may undergo profound degenerative changes responsible for significant hemodynamic abnormalities. The resulting valve disease may lead to a decreased life expectancy. In these patients, surgery was the only independent factor associated with long-term survival. Valve repair in the last two decades has demonstrated to be a valuable alternative to valve replacement in mitral valve 0 endocarditis. Mitral valve repair was associated with decreased hospital and long-term mortality, recurrent endocarditis and overall need for reoperation in comparison to valve replacement. Furthermore, repair limits the risks related to prolonged anticoagulation. However, these results suffer from several limitations: results of repair are dependent on the experience of surgical team, valve damage is usually less extended in patients undergoing repair as well clinical and hemodynamic impairment are more severe in patients undergoing replacement. Therefore, although repair should be preferred when technically feasible caution must be paid to assess its absolute superiority in comparison to valve replacement.

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Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry

Cited by 10 publications

References 25 publications

Contemporary trends and outcomes of mitral valve surgery for infective endocarditis

Contemporary trends and outcomes of mitral valve surgery for infective endocarditis

Valve replacement or repair in native mitral valve infective endocarditis—Which is better? A meta‐analysis and systematic review

Mitral valve repair in infective endocarditis: which evidence?

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