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The Journal of Thoracic and Cardiovascular Surgery, Vol 103, 124-128, Copyright © 1992 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
WG Hendren, AS Morris, ER Rosenkranz, BW Lytle, PC Taylor, WJ Stewart, FD Loop and DM Cosgrove
Twenty-two patients with mitral insufficiency resulting from native valve
endocarditis underwent mitral valve repair. Six patients had acute
endocarditis with positive blood cultures and active valve infection.
Sixteen patients were cured of active infection, but mitral insufficiency
developed as a result of prior infection. Mean age was 48.5 +/- 21.7 years;
13 (59%) were male. Mean New York Heart Association functional class was
2.6 +/- 1.2. Multiple valve lesions were present in 11 (50%) patients.
Valve abnormalities included leaflet perforation in 13 patients, chordal
rupture or elongation in 14, vegetations in 5; and annular abscess in 1. In
patients with acute endocarditis all macroscopically infected tissue was
excised. Multiple techniques were required to achieve valve competence.
Suture or patch closure of perforation was done in 14 patients, chordal
shortening or transfer in 9, leaflet resection and closure in 4, leaflet
resection with pericardial patching in 5, and annuloplasty in 15. Mitral
valvuloplasty was combined with other procedures in 11 (50%) patients.
There were two (9%) hospital deaths, both occurring in patients with healed
endocarditis. There was one (9%) death in a patient undergoing an isolated
procedure and one (9%) in a patient undergoing a combined procedure. Mean
follow-up was 24 +/- 16.8 months and was complete. Seventeen (85%) were in
New York Heart Association functional class I, and three (15%) were in
class II. There were no late deaths, reoperations, recurrent endocarditis,
thromboembolic events, or other valve-related morbidity. We conclude that
mitral valve repair for insufficiency resulting from bacterial endocarditis
(1) is possible in acute and healed disease, (2) has a low operative
mortality, and (3) has resulted in patients free of recurrent infection and
valve-related morbidity and mortality. Mitral valve repair is an attractive
alternate to valve replacement in bacterial endocarditis.
ARTICLES
Mitral valve repair for bacterial endocarditis
Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic Foundation, Ohio 44195-5066.
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