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J Thorac Cardiovasc Surg 2009;137:110-116
© 2009 The American Association for Thoracic Surgery

Acquired Cardiovascular Disease

Outcomes of surgical intervention for isolated active mitral valve endocarditis

Peter Munk Cardiac Centre, Toronto General Hospital, Toronto, Ontario, Canada

Received for publication May 11, 2008; revisions received July 5, 2008; accepted for publication July 20, 2008.

^_* Address for reprints: Christopher M. Feindel, MD, Antonio & Helga DeGasperis Chair in Clinical Trials and Outcomes Research, 200 Elizabeth Street, 4N-480, Toronto General Hospital, Toronto, Ontario, M5G 2C4, Canada. (Email: Chris.Feindel{at}uhn.on.ca).

Objective: Although several studies have examined the outcomes of mitral valve repair for infective endocarditis, no studies have documented the long-term outcomes of surgical intervention for active endocarditis confined to the mitral valve.

Methods: One hundred four patients underwent surgical intervention for active infective endocarditis confined to the mitral valve over a 27-year period (mean age, 50 ± 18 years; 52% female). The infected valve was native in 81 patients, previously repaired 6 patients, and prosthetic in 17 patients. Staphylococcus aureus was the most commonly isolated (32%) source of infection. Twenty-eight (27%) patients had annular abscesses. Surgical intervention consisted of valve repair or replacement for limited infection and radical resection, annular patch reconstruction, and valve replacement for annular abscess. Mean follow-up was 5.6 ± 4.4 years (range, 0–20 years) and was complete.

Results: There were 9 (8.7%) in-hospital deaths and 28 (27%) late deaths. Overall survival at 5, 7, and 10 years was 73% ± 5%, 68% ± 5%, and 58% ± 6%, respectively. At 7 years, freedom from recurrent endocarditis was 89% ± 4% and freedom from reoperation was 94% ± 3%. Event-free survival at 7 and 10 years was 60% ± 6% and 46% ± 7%, respectively, and was significantly higher in patients with native endocarditis versus those with nonnative endocarditis (ie, prosthetic or previously repaired; 7 years: 63% ± 7% vs 50% ± 12%, P < .005). Preoperative shock, S aureus infection, and bioprosthesis insertion were independent predictors of death from all causes. The patients in the bioprosthesis group were older (57 ± 20 years vs 44 ± 15 years in the mechanical group and 46 ± 12 years in the repair group, P = .003).

Conclusions: Surgical intervention for isolated active mitral valve endocarditis remains difficult, with high morbidity and mortality in the long term. Event-free survival is worse in those who have nonnative mitral valve endocarditis.