Mitral valve repair for infective endocarditis: Kobe experience

Abstract

Objectives We retrospectively analyzed our experience of mitral valve repair for native mitral valve endocarditis in a single institution. Methods From January 1991 to October 2011, 171 consecutive patients underwent surgery for infective endocarditis. Of these, 147 (86%) had mitral valve repair. At the time of surgery, 98 patients had healed (group A) and 49 had active infective endocarditis (group B). Repair procedures included resection of all infected tissue and thick restricted post-infection tissue, leaflet and annulus reconstruction with treated autologous pericardium, chordal reconstruction with polytetrafluoroethylene sutures, and ring annuloplasty if necessary. Fifty-two (35%) patients required concomitant procedures. The study endpoints were overall survival, freedom from reoperation, and freedom from valve-related events. The median follow-up was 78 months. Results There was one hospital death (hospital mortality 0.7%). Survival at 10 years was 88.5% ± 3.5% with no significant difference between the two groups ( p = 0.052). Early reoperation was required in 4 patients in group B due to persistent infection or procedure failure. Freedom from reoperation at 5 years was 99% ± 1.0% in group A and 89.6 ± 4.0% in group B ( p = 0.024). Event-free survival at 10 years was 79.3% ± 4.8% (group A: 83.4% ± 5.9%, group B: 72.6% ± 6.9%, p = 0.010). Conclusions Mitral valve repair was highly successful using autologous pericardium, chordal reconstruction, and ring annuloplasty if required. Long-term results were acceptable in terms survival, freedom from reoperation, and event-free survival. Mitral valve repair is recommended for mitral infective endocarditis in most patients.

Valve replacement or repair in native mitral valve infective endocarditis—Which is better? A meta‐analysis and systematic review

“…De Kerchove et al 32 used repair‐oriented surgical methods, such as no‐patch techniques including triangular or quadrangular resection, sliding plasty, neochordae, and chordal transfer; patch techniques including pericardium, tricuspid autografting, the flip‐over technique, and partial mitral valve homografting; ring annuloplasty; and pericardial banding, which achieved a reparability rate of 80%. Okada et al 33 reported their experience in MVP for IE from 1991 to 2011, including a total of 147 patients who underwent repair procedures. These authors concluded that repair was very successful using autologous pericardium, ePTFE sutures, and ring annuloplasty, with a 10‐year survival rate of 88.5 ± 3.5%, a 5‐year freedom from reoperation rate of 99 ± 1.0%, and a freedom from valve‐related events rate of 94.4 ± 2.4%.…”

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

“…Despite several studies reporting a superior overall survival of mitral valve repair (MVR) techniques over replacement, [3][4][5][6] this approach might be limited or not feasible when a large amount of mitral tissue needs to be resected or, even worse, is lacking, thus limiting the reparability or increasing the complexity of the repair. In this scenario, concerns have been raised about durability of the repair, especially in technically challenging cases.…”

Wegetacje na zastawce dwudzielnej u 16-letniej dziewczynki leczonej chirurgicznie metodą małoinwazyjnej rekonstrukcji

“…Valvular plastic surgery can provide better long-term survival and improved heart performance compared to valve replacement [5]. The right time for patients to undergo a correction is a matter of discussion, and the current tendency is to shorten the diagnosis-surgery period [7][8][9][10]. The present patient had a problem because she was under 18 years of age.…”