Approach to Mitral Valve Repair in Infective Endocarditis: Single Center, Single Surgeon, Cross Sectional Study

Abstract

Objective: The traditional approach was to replace the mitral valve on infective endocarditis when the response to antibiotic therapy is poor. The decision to repair the mitral valve (MV) in this setting is more challenging. This study analysed the different approaches adopted to perform a successful repair. Methods: This retrospective cross sectional study composed of all the patients referred to a single surgeon at Kandy National Hospital, Sri Lanka over a period from June 2011 to August 2020. Repair of MV in every case was the primary approach. Different types of lesion found on direct visual assessment, techniques adopted and outcome of MV repair in native MV infective endocarditis were analysed. Results: Total number of cases was 23, (16 males, 7 females) with a mean age of 42 years. MV repair was successful in all (95%) except one case, as per the intra-operative assessment made (saline test and trans esophageal echocardiography). Vegetation or leaflet perforation were the most common lesions (Posterior mitral valve leaflet/PMVL: 18, Anterior leaflet/AMVL: 7) followed by chordal rupture (6). The table shows the repair strategies used. One death occurred on postoperative third day following MV repair due to rupture of cerebral mycotic aneurysm. 22 patients were discharged home with satisfactory pre-discharge transthoracic 2D echocardiography. Conclusions: The study shows successful repair of MV on infective endocarditis is possible in majority of cases with skilled modulation of surgical approach to individual patient pathology found at the time of surgery. Long term follow-up data requires for the assessment of durability of this approach. Procedure Number Annuloplasty ring (flexible, rigid) 22 Pericardial patchAMVLPMVL 12 Folding plasty 2 Neochords 5 Triangular resection and repairAMVLPMVL 12 Quadrangular resection and repairAMVLPMVL 50 Resection and slidingplastyAMVLPMVL 26