Seven-year Cohort Study of Valvular Repair or Replacement for Active Mitral Endocarditis

Abstract

Purpose: Although surgical repair has better results than replacement for non-infective mitral valve pathology, there is mixed results in the context of mitral valve endocarditis. Our study compared the characteristics and outcomes of mitral valve replacement and repair for infective endocarditis. Methods: All cases of mitral replacement or repair for endocarditis during 2005–2011 at Auckland City Hospital were identified for retrospective analyses. Results: There were 25 mitral repairs and 35 mitral replacements studied, followed for 3.9 ± 2.5 years. Replacement patients were older (52.1 vs 43.1 years, p = 0.029), with more having prosthetic valve involvement (42.9% vs 8.0%, p = 0.004), intracardiac abscess (25.7% vs 4.0%, p = 0.035), previous endocarditis (17.1% vs 0.0%, p = 0.036), worse renal function (83 vs 115 ml/min, p = 0.013), higher operative risk scores (p = 0.004–0.020) and longer operation times (186 vs 115 min, p < 0.001). Despite this, operative mortality (4.0% vs 8.6%, p = 0.634), composite morbidity (16.0% vs 28.6%, p = 0.357), one and five year survival (96.0% and 92.0% vs 91.2% and 91.2%, p = 0.564), freedom from recurrent endocarditis (100.0% and 100.0% vs 90.6% and 87.0%, p = 0.081) and freedom from redo operation (95.8% and 84.9% and 96.8% and 86.6%) were similar between the two groups. In multi-variate analyses, predictors identified were for operative mortality: pre-operative inotrope or intra-aortic balloon pump treatment; mortality during follow-up: dialysis; composite morbidity: intracardiac abscess and hypercholesterolaemia; recurrent endocarditis: previous endocarditis; and redo operation: previous cerebrovascular accident. Conclusion: Although having patients with more baseline risk factors, mitral valve replacement had similar post-operative mortality, morbidity, recurrent endocarditis and redo surgery rates to mitral valve repair.