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 4 publications

(9 citation statements)

References 30 publications

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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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Mitral valve repair and replacement in infectious endocarditis: a systematic review and meta-analysis of clinical outcome

Nuthalapati,

Bathinapattla,

Cardoso

et al. 2024

Egypt Heart J

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Background Infective endocarditis (IE) poses significant clinical challenges, often necessitating surgical intervention for improved patient outcomes. The choice between mitral valve repair (MVP) and mitral valve replacement (MVR) is crucial in managing IE. This systematic review and meta-analysis aims to compare the effectiveness of MVP and MVR in treating IE, focusing on outcomes such as postoperative bleeding, mortality, recurrent endocarditis, and stroke. Main text A comprehensive literature search was conducted following PRISMA guidelines. Studies directly comparing MVP and MVR in IE patients were included. Data extraction and quality assessment were performed, and meta-analysis was conducted using RevMan software. Thirty-two studies involving 82,123 patients were included. MVP was associated with significantly lower rates of postoperative bleeding (OR: 0.58, 95% CI: 0.40–0.84) and reduced long-term mortality (OR: 0.40, 95% CI: 0.32–0.51) compared to MVR. However, MVR showed lower rates of recurrent endocarditis. MVP was also associated with a decreased likelihood of postoperative stroke (OR: 0.52, 95% CI: 0.40–0.68).2, 4 Conclusions MVP demonstrates advantages over MVR in reducing postoperative bleeding, long-term mortality, and stroke risk in IE patients. However, individual patient factors and surgical expertise must be considered in treatment decisions. Further research, including randomized controlled trials, is needed to validate these findings and refine treatment algorithms for IE management.

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

Cited by 4 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

Mitral valve repair and replacement in infectious endocarditis: a systematic review and meta-analysis of clinical outcome

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