Impact of Lesion Localization on Durability of Mitral Valve Repair in Infective Endocarditis

Abstract

Mitral valve (MV) repair for infective endocarditis (IE) is sometimes challenging. We investigated the durability of repair associated with the location of the infected lesion. The study comprised 83 patients (55 ± 18 years; active, 66; healed, 17) who underwent MV repair at our institution. Patients were categorized into 5 types based on the location of the main lesion: type I, posterior leaflet (n= 36); type IIC, clear zone of anterior leaflet (n= 12); type IIR, rough zone of anterior leaflet (n= 28); and type III, annulus (n= 7). Type IIR was divided into 2 subgroups: IIR-large (>1 segment involvement, n= 9) and IIR-small (1 segment, n= 19). Follow-up was 95.2% completed for 7.2 ± 5.2 years. The rate of recurrent moderate or severe mitral regurgitation (MR) was 2.8% in type I, 0% in type IIC, 28.6% in type IIR, and 14.3% in type III. The freedom from recurrent moderate or severe MR was significantly lower in type IIR compared with the other types (63.1% ± 10.6% vs 96.8 ± 3.2% at 5 years, P< .001). Moreover, the recurrence rate was higher in type IIR-large (55.6%) than in type IIR-small (15.8%, P= .068). Type IIRwasan independent predictor of recurrent MR (hazard ratio, 11.1, 95% confidence interval, 2.52-78.2; P= .001). The durability of MV repair for IE was satisfactory in posterior leaflet infection without annulus invasion and in clear zone infection of the anterior leaflet. However, rough zone infection of the anterior leaflet, especially with more than 1 segment involvement, was associated with a high risk of recurrent MR.