Mitral valve repair is better than mitral valve replacement in native mitral valve endocarditis: Results from a prospective matched cohort

Oliver, Léopold; Leauthier, Marie; Jamme, Matthieu; Arregle, Florent; Martel, Hélène; Philip, Mary; Gouriet, Frédérique; Casalta, Jean Paul; Torras, Olivier; Casalta, Anne-Claire; Camoin-Jau, Laurence; Lavagna, F; Renard, Sébastien; Ambrosi, Pı̈erre; Lépidi, Hubert; Collart, Frédéric; Hubert, Sandrine; Drancourt, Michel; Raoult, Didier; Ribéri, Alberto; Habib, Gilbert

doi:10.1016/j.acvd.2022.02.002

Cited by 3 publications

(2 citation statements)

References 18 publications

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“…Most of these events occurred within the first 3 years of follow-up. These outcomes were confirmed in a recent meta-analysis by He et al , 13 where MVR was associated with a lower incidence of recurrences, thus suggesting that the prosthetic valve itself represents a plausible risk factor for endocarditis relapse 18,19 . Opposite results were reported by Cuerpo et al , 15 along with Ruttmann et al 16 and Defauw et al , 14 where no differences were found in terms of infective endocarditis relapse.…”

Section: Discussionmentioning

confidence: 71%

“…These outcomes were confirmed in a recent meta-analysis by He et al, 13 where MVR was associated with a lower incidence of recurrences, thus suggesting that the prosthetic valve itself represents a plausible risk factor for endocarditis relapse. 18,19 Opposite results were reported by Cuerpo et al, 15 along with Ruttmann et al 16 and Defauw et al, 14 where no differences were found in terms of infective endocarditis relapse. Despite controversies, in this study, we highlighted infective endocarditis as an independent predictor of mortality regardless of the surgical strategy (hazard ratio 4.03; 95% CI 1.41-11.52; P ¼ 0.009).…”

Section: Discussionmentioning

confidence: 84%

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Mitral valve surgery in acute infective endocarditis: long-term outcomes of mitral valve repair versus replacement

Bacco

D’Alonzo

Mauro

et al. 2023

Journal of Cardiovascular Medicine

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Aims Timing and surgical strategies in acute infective endocarditis are still questionable. We sought to investigate clinical outcomes of patients undergoing mitral valve repair (MVR) compared with mitral valve replacement [mitral valve prosthesis (MVP)] for acute infective endocarditis. Methods From 2004 to 2019, 109 consecutive patients with acute mitral valve infective endocarditis were retrospectively investigated. Patients were divided into two groups according to surgical strategy: MVR 53/109 (48.6%) versus MVP 56/109 (51.4%). Primary end points were in-hospital mortality and overall survival at 10 years. Secondary end point was the freedom from infective endocarditis relapse. Results Our institutional surgical approach for infective endocarditis allowed us to achieve MVR in 48.6% of patients. Hospital mortality was comparable between the two groups [MVR: 1/53 (1.9%) versus MVP: 2/56 (3.6%), P = 1.000]. Overall 10-year survival was 80.0 ± 14.1 and 77.2 ± 13.5% for MVR and MVP, respectively (P = 0.648). MVR showed a lower incidence of infective endocarditis relapse compared with MVP (MVR: 93.6 ± 7.1 versus MVP: 80.9 ± 10.8%, P = 0.041). At Cox regression, infective endocarditis relapse was an independent risk factor for death (hazard ratio 4.03; 95% confidence interval 1.41–11.52; P = 0.009). Conclusion The tendency to postpone surgery in stable patients with mitral infective endocarditis allowed achievement of MVR in almost 50% of patients. Although repair remains the approach of choice in our institution, no differences between MVR and MVP were reported in terms of early/late survival. However, MVP had a higher incidence of infective endocarditis relapse that represents an independent risk of mortality.

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Section: Discussionmentioning

confidence: 71%

Section: Discussionmentioning

confidence: 84%

Mitral valve surgery in acute infective endocarditis: long-term outcomes of mitral valve repair versus replacement

Bacco

D’Alonzo

Mauro

et al. 2023

Journal of Cardiovascular Medicine

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Which trial do we need? Elective early surgical treatment of left-sided infective endocarditis

Fernández‐Ruiz¹,

Paz‐Artal²

2023

Clinical Microbiology and Infection

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To repair or to replace in mitral valve infective endocarditis? an updated meta-analysis

Awad,

Wilson,

Elnagar

et al. 2024

J Cardiothorac Surg

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Background Valve infective endocarditis (IE) is a potentially life-threatening condition that affects patients’ livelihoods. Current surgical options in mitral valve IE include mitral valve repair (MVr) or replacement (MVR). While each procedure boasts its merits, doubt remains as to which type of surgery is superior. Methods We searched PubMed, Scopus, Web of Science, and Cochrane literature databases for studies comparing MVR and MVr in mitral valve IE. Any randomized controlled trial (RCT) or observational studies that compare MVR vs. MVr in mitral valve IE were eligible. Our dichotomous outcomes were extracted in the form of event and total, and risk and hazard ratio (RR)(HR) with 95% confidence interval (CI) and were pooled and calculated using RevMan 5.0. Results Our study included 23 studies with a total population of 11,802 patients. Compared to MVR, MVr had statistically significant lower risks of both early mortality with RR [0.44; 95% CI, 0.38–0.51; p < 0.001] and long-term follow-up mortality with HR [0.70; 95% CI, 0.58–0.85; p = 0.0004]. Moreover, MVr was associated with a statistically significant lower risk of IE recurrence with RR [0.43; 95% CI, 0.32–0.58; p < 0.001]; however, no statistically significant differences between both groups in terms of re-operations with RR [0.83; 95% CI, 0.41–1.67; p = 0.60]. Conclusion Our results suggest that MVr was superior in terms of in-hospital mortality, long-term survival, and risk of recurrence without significance in valve reoperation. Therefore, MVr is appropriate as a primary treatment choice and should be considered whenever possible in most IE patients.

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Mitral valve repair is better than mitral valve replacement in native mitral valve endocarditis: Results from a prospective matched cohort

Cited by 3 publications

References 18 publications

Mitral valve surgery in acute infective endocarditis: long-term outcomes of mitral valve repair versus replacement

Mitral valve surgery in acute infective endocarditis: long-term outcomes of mitral valve repair versus replacement

Which trial do we need? Elective early surgical treatment of left-sided infective endocarditis

To repair or to replace in mitral valve infective endocarditis? an updated meta-analysis

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