Extending the scope of mitral valve repair in active endocarditis
(2012) The Journal of Thoracic and Cardiovascular Surgery — Vol. 143, n° 4, p. S91-S95 (2012)
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- Abstract
- Objective: During the last 2 decades, we have applied a repair-oriented surgical approach to patients with active mitral valve endocarditis. We retrospectively analyzed the long-term outcomes with this repair-oriented approach. Method: Between 1991 and 2010, 137 patients underwent operation for active mitral valve endocarditis; of these, 109 patients (80%) had mitral valve repair and represent the study cohort. Repair techniques without patch extension (no-patch techniques) include triangular or quadrangular resection (n = 49), sliding plasty (n = 24), neochordae (n = 18), chordal transfer (n = 12), and others (n = 5). Repair techniques using patch extension (patch techniques) included pericardium (n = 42), tricuspid autograft (n = 8), flip-over technique (n = 7), and partial mitral valve homograft (n = 5). Patches were used in 67 patients (61%). Ring annuloplasty was performed in 60 patients, and a pericardial band was used in 13 patients. Clinical and echocardiographic follow-up were performed. Median follow-up was 48 months. Results: Hospital mortality was 16%. At 8 years, overall survival was 62% ± 10% with no differences between patients with or without patch repair (P =.5). Freedom from mitral valve repair failure was 81% ± 14% in patients with patch repair and 90% ± 10% in patients without patch repair (P =.09). The rate of thromboembolic or bleeding event was 1% per patient-year, and the rate of endocarditis recurrence was 0.3% per patient-year. Univariable predictors of mortality were age more than 70 years (P <.0001), perivalvular abscess (P = .002), diabetes mellitus (P =.0002), and renal failure (P =.04). Predictors of repair failure were renal failure (P =.035) and perivalvular abscess (P =.033). Conclusions: In active mitral valve endocarditis, a repair-oriented surgical approach achieves a reparability rate of 80% with acceptable morbidity and good long-term results. The use of patch techniques offers a durability rate that approximates the rate obtained with the no-patch techniques. © 2012 by The American Association for Thoracic Surgery.
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de Kerchove, L., Price, J., Tamer, S., Glineur, D., Momeni, M., Noirhomme, P., & El Khoury, G. (2012). Extending the scope of mitral valve repair in active endocarditis. The Journal of Thoracic and Cardiovascular Surgery, 143(4), S91-S95. https://doi.org/10.1016/j.jtcvs.2012.01.049 (Original work published 2012)