P47 MITRAL VALVE REPAIR FOR INFECTIVE ENDOCARDITIS: A PROPENSITY MATCHED STUDY

Abstract

Abstract Background The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis remain not clearly established. We aim to review the clinical experience in mitral valve surgery for infective endocarditis looking at mid–term survival. Methods Prospectively collected data of patients who underwent cardiac surgery for infective endocarditis between 2001 and 2021 at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest–neighbour propensity score matching, including twelve preoperative variables, was performed to account for differences in patients’ profile between the repair and replacement subgroups. Results In the unmatched populations, mean age of the patients was 60±15 years and 72% were male. Active infective endocarditis was described in 226 cases (80%). Thirty–four patients (12%) suffered cerebral embolism and in 10% of the cases preoperative inotropic support and/or mechanical ventilation were required. Associated procedure were CABG, aortic valve replacement and tricuspid valve repair, 13%, 36% and 9% of the cases, respectively. Mitral valve repair was performed in 96 cases (32%). Overall in–hospital mortality was 6.7% and was not significantly different between patients who underwent repair or replacement of the mitral valve (7.2% vs 6.4%, p = 0.79). Propensity matching provided 72 well–matched pairs. Mean age was 59±15 years, 75% of the patients were male. Sixteen patients (11%) had a recent cerebral event. An emergency operation was carried out in 15% of the cases, 10% of the patients presented a NYHA class>III and 14 patients (10%) underwent a redo procedure. CABG and aortic valve replacement were associated in 14% and in 35% of the cases, respectively. Overall in–hospital mortality was 6.9% with no difference between the repair and the replacement cohorts 9.7% vs 4.2%, respectively (p = 0.19). Survival probabilities at 1–, 5– and 10–years were 89%, 71% and 67%, respectively after mitral repair, and 90%, 77% and 57%, respectively after mitral replacement; log–rank p = 0.90. Conclusions Mitral valve repair was associated with acceptable in–hospital mortality and survival in a high–risk and comorbid cohort of patients with mitral valve infection. We found no difference in early and mid–term survival between patients who underwent repair or replacement of the mitral valve in the setting of infective endocarditis.