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J Thorac Cardiovasc Surg 2005;130:765-771
© 2005 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Mitral valve repair provides improved outcome over replacement in active infective endocarditis

^a Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
^b Department of Cardiology, and Medical Statistics, Informatics, Innsbruck Medical University, Innsbruck, Austria
^c Department of Health Economics, Innsbruck Medical University, Innsbruck, Austria

Received for publication December 30, 2004; revisions received February 22, 2005; accepted for publication March 10, 2005.

^_* Address for reprints: Elfriede Ruttmann, MD, Department of Cardiac Surgery, Innsbruck Medical University, Anichstrasse 35, 6020 Innsbruck, Austria (Email: elfriede.ruttmann{at}uibk.ac.at).

OBJECTIVES: Mitral repair in active infective endocarditis still remains controversial. Several studies demonstrate the feasibility of mitral repair in infective endocarditis; however, superiority of repair has never been shown. The aim of the investigation was to compare valve repair and valve replacement in respect to the extent of destruction and to analyze survival, recurrent endocarditis, and reoperation (event-free survival).

METHODS: Sixty-eight consecutive patients underwent surgical intervention for mitral endocarditis. Thirty-four (50%) patients had valve repair, and 34 (50%) patients had valve replacement. Leaflet destruction involving at least one mitral leaflet was present in 15 (44.1%) patients of the repair group and 11 (32.4%) patients of the replacement group. Repair of the mitral annulus with pericardium was performed in 4 (11.8%) patients in the repair group and 3 (8.8%) patients in the replacement group. Patients in both groups were similar concerning the progression of valvular destructions and comorbidities.

RESULTS: Hospital mortality was 11.8% (8 patients). No significant differences were found in all baseline parameters, with the exception of a higher incidence of previous septic embolism and sepsis in the repair group. Actuarial event-free survival at 1 year was 88.2% in the repair group compared with 67.7% in the replacement group, and 5-year event-free survival was 80.4% in the repair group and 54.6% in the replacement group (P = .015). Mitral valve repair remained the superior treatment regarding event-free survival in the multivariate analysis (hazard ratio, 0.33; 95% confidence interval, 0.12-0.93; P = .02).

CONCLUSIONS: Mitral valve repair offers excellent early and late results and is the preferable treatment option in the surgical therapy of native infective endocarditis.

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