Isolated Repair versus Replacement for Infective Native Mitral Valve Endocarditis

Objectives: The aim of this study is to compare perioperative parameters, and morbidity and mortality associated with mitral valve repair versus mitral valve replacement in patients with mitral valve infective endocarditis.

Methods: Between January 2012 and December 2018, a total of 2,450 mitral valve (MV) procedures were performed in our institution. Patients with infective endocarditis were compared: MV repair (group 1) vs. MV replacement (group 2). We excluded combined procedures and re-operations, resulting in 24 (group 1) and 45 patients (group 2) for further analysis. Mean age was 54.5 ± 19 years (group 1) vs 62.0 ± 14.0 years (group 2; p = 0.106), 42 vs. 40% were female (p > 0.999), respectively. 79.2% vs. 80.0% presented with severe mitral regurgitation (p > 0.999). Access was a lateral minithoracotomy in 42% in group 1 vs. 20% in group 2 (p = 0.088).

Results: Streptococcus species endocarditis was most frequent in both groups (41.7 vs. 33.3%, p = 0.601). Preoperative septic embolic events were similar in group 1 vs. 2 (25.0 vs. 28.9%, p = 0.785). Operation times, CPBT, and ACCT were not significantly different between groups (group 1: 227.5 ± 56.2, 144.3 ± 44.8, 92.6 ± 19.7 min vs. group 2: 217.7 ± 74.1, 129.0 ± 58.5, 82.7 ± 38.8 min; p = 0.739, 0.345, 0.318). Duration of ICU stay and ventilation times were significantly shorter in group 1 (2.0 ± 1.5 days, 6.2 ± 4.1 hours vs. 4.2 ± 4.6 days, 15.6 ± 16.7 hours; p = 0.002, < 0.001). Duration of overall hospital stay was similar (group 1: 9.1 ± 2.8 days vs. group 2: 10.9 ± 7.9 days; p = 0.120). In-hospital mortality was 0 vs. 4.4% in group 1 vs. 2 (p = 0.540) One patient required a repeat MV repair in each group (p > 0.999). Postoperative pacemaker implantation (0 vs. 11%; < p < 0.001) and new-onset dialysis (0 vs. 8.9%; < p < 0.001) was significantly more frequent in group 2. Reexploration for bleeding was observed in 4.2 vs. 6.7% (p > 0.999), transfusion in 20.8 vs. 40.0% (p = 0.180), group 1 vs. 2, respectively. Discharge echocardiography showed sufficient repair of the MV in all patients of group 1 with a residual regurgitation of the MV ≤ 1 in 16.6% (n = 4), and a mean gradient of 4.1 ± 2.8 mm Hg in group 1 vs. 5.7 ± 2.3 mm Hg in group 2 (p = 0.074).

Conclusion: Mitral valve repair has good clinical and functional outcomes with shorter ICU and ventilation times, and lower postoperative complication rates, and therefore should be first line strategy in eligible patients. Direct comparability of groups is limited to differing extent of leaflet damage.