Contemporary trends and outcomes of mitral valve surgery for infective endocarditis

Abstract

Background Contemporary data on mitral valve (MV) surgery in patients with infective endocarditis (IE) are limited. Methods The National Inpatient Sample was queried to identify patients with IE who underwent MV surgery between 2003 and 2016. We assessed (a) temporal trends in the incidence of MV surgery for IE, (b) morbidity, mortality, and cost of MV repair vs replacement, and (c) predictors of in‐hospital mortality. Results The proportion of MV operations involving patients with IE increased from 5.4% in 2003 to 7.3%, and the proportion of MV repair among those undergoing surgery for IE increased from 15.2% to 25.0% (Ptrend < .001). In‐hospital mortality was higher in the replacement group (11.3% vs 8.1%; P < .001), and this excess mortality persisted after propensity score matching (11.2% vs 8.1%; P < .001), and in sensitivity analyses excluding concomitant surgery (unadjusted 11.3% vs 4.8%; adjusted 8.5% vs 4.5%; P < .001), and stratifying patients by the time of operation (within 7 days, 11.3% vs 6.8%; P < .001 and >7 days, 11.9% vs 9.1%; P = .012). In the propensity‐matched cohorts, shock and need for tracheostomy were more frequent in the replacement group, but rates of stroke, pacemaker implantation, new dialysis, and blood transfusion were similar. Mitral valve repair was, however, associated with shorter hospitalizations, more home discharges, and less cost. In a multivariate regression analysis, age above 70 and chronic dialysis were the strongest predictors of in‐hospital mortality. Conclusion Mitral valve repair in IE patients is associated with lower in‐hospital mortality, resource utilization, and cost compared with MV replacement.

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

“…The current study presents a 15-year experience in a high-volume single-centre comparing the long-term outcomes of MVr and MVR in native valve endocarditis. As a specialist centre, we found that MVr was feasible in 46% of patients, higher than numerous contemporary studies [9,10,16,17]. Patients unsuitable for MVr were more likely to be higher risk (higher logistic EuroSCORE, non-elective, active IE).…”

“…Despite these clear recommendations, MVr rates have lagged. The National Inpatient Sample in the USA report a repair rate of 25% [9] and the Taiwan National Health Insurance program report a repair rate of 21% [10]. This could be due to concerns over the durability of MVr and recurrence of IE especially in active endocarditis and in non-elective surgery.…”

Steep rise in drug use-associated infective endocarditis in West Virginia: Characteristics and healthcare utilization

“…Despite these potential limitations, a major strength of our study is that rather than relying solely on ICD codes as multiple prior studies have done [6,9,20,29,30], we validated IE and drug use diagnoses with other clinical indicators through a detailed chart review. Use of ICD code combinations for identification of DU-IE are not specific and frequently fail to identify DU-IE cases correctly [31].…”

Mitral valve repair in infective endocarditis: which evidence?

“…In the last decade, the number of patients with IE undergoing MV surgery has increased significantly as well as the number of mitral valve repair [18] . However, the percentage of repair vs. replacement showed high variability in different centers.…”