Outcomes of mitral valve repair in acute native mitral valve infective endocarditis

Abstract

OBJECTIVESMitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis.METHODSBetween January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events.RESULTSThe mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively.CONCLUSIONSAlthough MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.

Outcomes of emergency or urgent mitral valve repair in patients with papillary muscle rupture and active infective endocarditis

“…In our study, although the CPB and crossclamp times in the active IE subgroup were comparable to or even shorter than in previous studies, 21 , 22 they were significantly longer than in the elective IE subgroup. This result may have been the consequence of more fragile tissue due to the active infectious phase, which increased the complexity of surgery.…”

“…In previous studies, the early mortality after MV repair in active IE ranged from 0% to 16%. 21,22,[24][25][26][27][28] With increasing experience in MV repair and optimal perioperative anti-infection management at our institution, emergency or urgent MV repair before completion of antibiotic therapy can achieve outcomes equivalent to those of elective surgery. Therefore, surgery should not be delayed if guideline-based indications are present.…”

Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies

“…Further, results of blood cultures can be inconclusive due to contamination by commensal bacteria, a complex polymicrobial biofilm (Oberbach et al, 2017), or insufficient amounts of bacteria to culture. Negative blood cultures are found in approximately 24% of all IE cases, which is similar for NVE (25%), CDRIE (26%), and PVE (23%) (Hussein et al, 2016;Koneru et al, 2018;Calais et al, 2019;de Camargo et al, 2019;El Gabry et al, 2019;Habib et al, 2019;Heriot et al, 2019;Nesterovics et al, 2019;Płońska-Gościniak et al, 2019;San et al, 2019;Witten et al, 2019;Bohbot et al, 2021;Duval et al, 2021;Jędrzejczyk-Patej et al, 2021;Michałowska et al, 2021;Pyo et al, 2021).…”

“…Microorganism prevalence was evaluated based on all IE, NVE, CDRIE, PVE ( Figure 2 ). Staphylococcus aureus accounts for 27% of NVE, followed by streptococci (26%), and enterococci (12%) ( de Camargo et al, 2019 ; El Gabry et al, 2019 ; Habib et al, 2019 ; Heriot et al, 2019 ; San et al, 2019 ; Chambers and Bayer, 2020 ; Hubers et al, 2020 ; Bohbot et al, 2021 ; Duval et al, 2021 ; Pyo et al, 2021 ). Coagulase-negative staphylococci have a prevalence of 6.3% in NVE, which is in contrast to CDRIE with 25.2% ( Hussein et al, 2016 ; Koneru et al, 2018 ; Calais et al, 2019 ; Habib et al, 2019 ; Nesterovics et al, 2019 ; San et al, 2019 ; Witten et al, 2019 ; Bohbot et al, 2021 ; Duval et al, 2021 ; Pyo et al, 2021 ).…”

Mitral valve repair in infective endocarditis: which evidence?

“…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.…”