Mitral valve repair in infective endocarditis: which evidence?

Abstract

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.

Valve Endocarditis, to repair or not to repair, is that really the question?

“…Browsing the literature, we probably found a possible answer to this doubt; Very recently, Rostagno [16] summarized the features that may lead surgeon towards either repair or replacement: single scallop or leaflet valve involvement, isolated vegetation, valve perforation, less extensive valve damage with enough tissue after debridement favor MVP, in all other cases we do not have to fear to implant a prosthesis When valve replacement is required, there is little evidence that risk of recurrent infection is different between mechanical and tissue prostheses. The use of bioprosthetic valves may avoid postoperative anticoagulation, lowering the risk of hemorrhagic conversion of strokes and other bleeding complications.…”

Valve endocarditis, to repair or not to repair, is that really the question?

“…Browsing the literature, we probably found a possible answer to this doubt. Very recently, Rostagno 16 summarized the features that may lead surgeons towards either repair or replacement: single scallop or leaflet valve involvement, isolated vegetation, valve perforation, less extensive valve damage with enough tissue after debridement favor MVP, in all other cases we do not have to fear to implant a prosthesis.…”