Should more patients be offered repair for mitral valve endocarditis? a single-centre 15-year experience

Ling, Clarissa Ng Yin; Bleetman, David; Pal, S; Leung, Hing Chi Kristie; Khan, Habib; Whitaker, Donald; Wendler, Olaf; Deshpande, Ranjit; Baghai, Max

doi:10.1186/s13019-022-01997-2

Cited by 3 publications

(9 citation statements)

References 30 publications

(30 reference statements)

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“…The yellow area (-0.1; 0.1) defines an interval of acceptable differences. 15 13 [9][10][11][12][13][14][15][16][17][18][19][20][21][22] 15 [10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25] 11 [8][9][10][11][12][13][14][15][16][17][18][19] 0.013 compares well with recent data from national registries and high-volume centres' experiences reporting an average rate of early death ranging from 3% to 12%. [1][2][3][4] Patients with infection present a systemic involvement and are burdened by the occurrence of local and peripheral complications that account for the increased surgical risks.…”

Section: Recent Cerebral Strokesupporting

confidence: 64%

“…Most of these experiences, however, failed to characterise and analyse important factors such as patients' clinical presentation and the extension of the infective process. 2,8,10,11,12 Furthermore, in unmatched studies, mitral replacement cohorts included sicker patients who were older with a higher prevalence of active infection and heart failure and presenting with more severe lesions. 3,19,20 Not surprisingly, valve replacement is still the most common surgery for mitral valve infective endocarditis, as national registries report that mitral repair is performed in approximately 20-30% of the cases.…”

Section: Recent Cerebral Strokementioning

confidence: 99%

“…In contrast, mitral valve replacement has been usually performed in acute and urgent cases with a more extensive tissue disruption. 2,3,8,[10][11][12] Propensitymatch studies have tried to overcome this limitation, but rarely were able to account for the anatomy and the extent of infective lesions.…”

Section: Introductionmentioning

confidence: 99%

“…[1][2][3][4] Several studies suggested that a better early and long-term survival and a lower risk of reinfection/reoperation can be achieved with valve repair rather than valve replacement. 2,[5][6][7][8] Although this notion has been widely described and is universally accepted in the field of degenerative mitral valve disease, infective endocarditis is a highly heterogenous disease often associated with local and systemic complications that play a major role in patients' prognosis. 9 This makes it difficult to assess the impact of valve repair versus valve replacement.…”

Section: Introductionmentioning

confidence: 99%

“…There is a general tendency to offer valve repair to younger patients, with better cardiac function, a lower prevalence of severe heart failure, and often in an elective setting. In contrast, mitral valve replacement has been usually performed in acute and urgent cases with a more extensive tissue disruption 2,3,8,10–12 . Propensity-match studies have tried to overcome this limitation, but rarely were able to account for the anatomy and the extent of infective lesions.…”

Section: Introductionmentioning

confidence: 99%

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Surgical repair and replacement for native mitral valve infective endocarditis

Malvindi,

Luthra,

Zingale

et al. 2024

Journal of Cardiovascular Medicine

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Aims The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established. Methods Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001–2021) at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity-score matching was performed to account for differences in patients’ profile between the repair and replacement subgroups. Results Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94). Conclusions Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.

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Section: Recent Cerebral Strokesupporting

confidence: 64%

Section: Recent Cerebral Strokementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Surgical repair and replacement for native mitral valve infective endocarditis

Malvindi,

Luthra,

Zingale

et al. 2024

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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Surgery for Active Infective Endocarditis on Mitral Valve: Anatomical, Surgical, and Disease Factors as Long-Term Outcome Modifiers

Berretta,

Bifulco,

Luthra

et al. 2024

Medicina

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Background and Objectives: Determinants of long-term outcomes after surgery for native mitral valve endocarditis have not been thoroughly investigated. The aim of this study was to assess anatomical, disease, and surgical risk factors for long-term mortality and need of reintervention, in patients undergoing mitral valve surgery for active endocarditis. Materials and Methods: Patients who underwent surgery for active native mitral valve endocarditis at three academic centres, between 2000 and 2022, were analysed. The primary outcome was long-term survival. The secondary outcome was the freedom from mitral reoperation. Survival curves were constructed with Kaplan–Meier methodology. Multivariable Cox regression was used to identify demographic, anatomical, disease, and surgical factors associated with late mortality and reoperation. Results: 335 consecutive patients with active mitral endocarditis were analysed. Two hundred and one patients (70.5%) had infection confined to the valve cusp whereas 89 (25.6%) had invasive disease extended to the annulus and surrounding tissues. Preoperative neurological events occurred at the diagnosis in 52 cases. Streptococci were the most common causative organisms followed by Staphylococcus aureus, Coagulase-negative Staphylococcus, and Enterococcus. Valve repair was performed in 108 patients (32.2%). Survival at 5 and 10 years was 70.1% and 59.2%, respectively. Staphylococcus emerged as an independent predictor of late mortality, along with age, chronic obstructive pulmonary disease, and previous cardiac surgery. Survival was considerably reduced in patients with S. aureus compared with those without (log rank p < 0.001). The type of surgery (repair vs. replacement) did not emerge as a risk factor for late mortality and reoperation. Seventeen patients underwent mitral reoperation during the follow-up. The 5- and 10-year freedom from reoperation was 94.7% and 91.8%, respectively. Conclusions: Active mitral valve endocarditis remains a life-threatening disease with impaired survival. While lesion characteristics influenced surgical decision-making and intraoperative management, their impact on long-term survival and freedom from reintervention appears to be moderated by other factors such as infecting pathogens and patient comorbidities.

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Should more patients be offered repair for mitral valve endocarditis? a single-centre 15-year experience

Cited by 3 publications

References 30 publications

Surgical repair and replacement for native mitral valve infective endocarditis

Surgical repair and replacement for native mitral valve infective endocarditis

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

Surgery for Active Infective Endocarditis on Mitral Valve: Anatomical, Surgical, and Disease Factors as Long-Term Outcome Modifiers

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