Native Mitral Valve Infective Endocarditis Research Articles

Surgical repair and replacement for native mitral valve infective endocarditis.

The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis are not clearly established. Data of patients who underwent cardiac surgery for infective endocarditis over a 20-year period (2001-2021) 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 was performed to account for differences in patients' profile between the repair and replacement subgroups. Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair. Propensity match analysis provided 89 well matched pairs. Mean age was 60 ± 15 years; 75% of the patients were male. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment formed the majority of the cases undergoing mitral valve repair. There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair and the replacement cohorts. Survival probabilities at 1, 5 and 10 years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement (log-rank P = 0.94). Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and 10-year outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.

Anévrysme rénal infectieux retardé, 3 mois après chirurgie cardiaque pour une endocardite infectieuse à Streptococcus pyogenes ; cas et revue de la littérature

Infective endocarditis (IE) due to Streptococcus pyogenes (SP) (Group A Streptococcus) is uncommon and infectious renal artery aneurysm (IRAA) is an exceptional complication of IE, with few cases reported in the literature.We describe a case of SP native mitral valve IE in a 58-year-old man, presenting with large valve vegetations, abscess and severe regurgitation. Initial CT-angiography showed bilateral kidney and splenic infarcts.He underwent successful emergent bioprosthetic valve replacement. Antibiotic regimen consisted in linezolid and rifampicin for 8 weeks. Three months later, CT-angiography for feet gangrene revealed a 16mm aneurysm of the left intraparenchymal renal artery, which was occluded by coil-embolization.This case shows that an infectious aneurysm may develop several months after antibiotic treatment and emergent valve replacement for IE.

Infective Endocarditis Revealed after Resolution of COVID-19 Infection.

A 34-year-old previously healthy Japanese woman was diagnosed with COVID-19 and treated with remdesivir and dexamethasone. She was discharge but returned the next day due to acute myocardial infarction. Conservative treatment was selected because of an embolic occlusion in the distal portion. Contrast-enhanced computed tomography and brain magnetic resonance imaging revealed a right renal infarction and multiple cerebral embolisms, respectively; she had a fever of 38.9°C that night. Blood culture was positive for methicillin-susceptible Staphylococcus aureus. Transthoracic echocardiography revealed an 11-mm vegetation on the posterior mitral valve leaflet. Native mitral valve infective endocarditis causing multiple embolizations was diagnosed. She underwent surgical mitral valve replacement.

Native mitral valve infective endocarditis caused by Actinobacillus equuli

A 45-year-old woman with Brown-Séquard syndrome was admitted for fever, chills, diffuse pain, and headaches that had started 4 days before. She did not take any medication. Clinical examination and vital signs were normal. Laboratory tests showed a white blood cell count of 6100 per μL (4500–11 000 per μL) and a C-reactive protein concentration of 229·1 mg/L (<5·0 mg/L). Urinary analysis was normal. SARS-CoV-2 PCR test was negative. Chest x-ray, abdominal ultrasound, and brain CT were normal.

Infective endocarditis of mitral valve, valve replacement or repair?- a meta-analysis of 10,965 patients

Abstract Background Being characterized by high mortality and recurrence rates, native mitral valve infective endocarditis (IE) constitutes a burden on both patients and surgeons from its poor prognosis and debatable interventions. Mitral valve repair (MVRr) and mitral valve replacement (MVRp) are two main surgical methods. Nevertheless, which of them carries an outweigh benefit over the other is still controversial. Thus, in our meta-analysis we aimed to further investigate the efficacy of each technique on both short term and long-term outcomes. Methods Our search strategy was applied on several databases including the PubMed, Scopus, Web of science, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk and hazard ratio (RR and HR) and 95% confidence interval (CI) were pooled and analyzed using RevMan 5.0. Results A total of 22 relevant publications with a total population of 10,965 patients, with 3,557 patients having undergone MVRr and 7,408 patients having undergone MVRp, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR 0.44; 95% CI, 0.38–0.51; p&amp;lt;0.00001; I2=0%), a higher long-term survival rate (HR 0.56; 95% CI, 0.36–0.76; p&amp;lt;0.001; I2=0%), and a lower risk of recurrence (RR 0.66; 95% CI, 0.40–0.93; p=0.05; I2=0%). Although the risk of reoperation was observed lower for MVRr, it was not statistically significant (RR, 0.86; 95% CI, 0.36–1.36; p=0.76; I2=37%). Conclusion Our results suggests that MVRr showed superiority in the terms of in hospital mortality and long-term survival. Furthermore, it has lower risk of recurrence and valve reoperation. Therefore, MVRr is an appropriate as a primary treatment choice and should be considered whenever possible in most IE patients. Conclusion Our results suggests that MVRr showed superiority in the terms of in hospital mortality and long-term survival. Furthermore, it has lower risk of recurrence and valve reoperation. Therefore, MVRr is an appropriate as a primary treatment choice and should be considered whenever possible in most IE patients. Funding Acknowledgement Type of funding sources: None.

Editorial commentary: Native mitral valve infective endocarditis-Surgical concerns?

Editorial commentary: Native mitral valve infective endocarditis-Surgical concerns?

Long-term outcomes of mechanical versus biological valve prosthesis in native mitral valve infective endocarditis

Objectives. To study the long-term outcomes of mitral valve replacement with mechanical or biological valve prostheses in native mitral valve infective endocarditis patients. Desing. We conducted a retrospective, nationwide, multicenter cohort study with patients aged ≤70 years who were treated with mitral valve replacement for native mitral valve infective endocarditis in Finland between 2004 and 2017. Results. The endpoints were all-cause mortality, ischemic stroke, major bleeding, and mitral valve reoperations. The results were adjusted for baseline features (age, gender, comorbidities, history of drug abuse, concomitant surgeries, operational urgency, and surgical center). The median follow-up time was 6.1 years. The 12-year cumulative mortality rates were 36% for mechanical prostheses and 74% for biological prostheses (adj. HR 0.40; CI: 0.17–0.91; p = 0.03). At follow-up, the ischemic stroke had occurred in 19% of patients with mechanical prosthesis and 33% of those with a biological prosthesis (adj. p = 0.52). The major bleeding rates within the 12-year follow-up period were 30% for mechanical prosthesis and 13% for a biological prosthesis (adj. p = 0.29). The mitral valve reoperation rates were 13% for mechanical prosthesis and 12% for a biological prosthesis (adj. p = 0.50). Drug abuse history did not have a significant modifying impact on the results (interaction p = 0.51 for mortality and ≥0.13 for secondary outcomes). Conclusion. The use of mechanical mitral valve prosthesis is associated with lower long-term mortality compared to the biological prosthesis in non-elder native mitral valve infective endocarditis patients. The routine choice of biological mitral valve prostheses for this patient group is not supported by the results.

Outcomes of Mitral Valve Repair in Children With Infective Endocarditis: A Single-Center Experience

Mitral valve infective endocarditis (IE) in children is rare, and there are few reports on the outcomes of surgery in these patients. This study investigated the long-term outcomes of mitral valve repair in children with IE. Data were retrospectively obtained from medical records and correspondence. Univariable regression analyses were performed and outcomes including survival and freedom from reoperation were analyzed using the Kaplan-Meier method. Surgery for native mitral valve IE was performed in 39 patients between 1987 and 2020. Of these, 92.3% (36/39) of patients underwent mitral valve repair, while 7.7% (3/39) required replacement. Median age was 8 years. Preoperatively, 80.5% (29/36) of patients had moderate or greater mitral regurgitation. Congenital heart disease was present in 38.9% (14/36), while 11.1% (4/36) had rheumatic heart disease and 25.0% (9/36) had prior cardiac surgery. Postoperatively, only 1 patient (2.8%, 1/36) had moderate or greater residual mitral regurgitation. There were 2 early deaths (5.6%, 2/36), with survival being 94.1% (95%CI, 78.5-98.5) at 15 years. At 10 years, freedom from reoperation was 62.9% (95%CI, 41.0-78.5) while freedom from mitral valve replacement was 80.2% (95%CI, 55.5-92.3). Larger vegetation size was a risk factor for embolic events both pre- and postoperatively (OR, 1.15, P=0.02). Mitral valve repair is feasible in the majority of children requiring surgery for mitral valve IE. Survival is excellent, and at 10 years, approximately two-thirds of patients are free from mitral reoperation, and 80% are free from replacement. Larger vegetation size is associated with an increased risk of embolic events.

Native mitral valve endocarditis masquerading as ST-segment elevation myocardial infarction

Infective endocarditis (IE) can present with a myriad of clinical syndromes, which make initial clinical diagnosis elusive.[1–3][1] We describe a rare case of native mitral valve IE presenting with multi-territorial myocardial infarction and subsequently complicated by peripheral emboli and

Mitral valve repair is better than mitral valve replacement in native mitral valve endocarditis: Results from a prospective matched cohort

In native mitral valve infective endocarditis (NMIE), the respective values of mitral valve repair (MVRep) and replacement (MVR) are still debated. To compare MVRep and MVR in a large prospective matched cohort. Between 2010 and 2017, all consecutive patients operated on for NMIE in our centre were included prospectively. Clinical and outcome features were compared between the two groups. Primary endpoint was event-free survival, including death, reoperation and relapse. Univariate and multivariable survival analyses and a propensity score analysis were performed. Among 152 patients, 115 (75.7%) underwent MVRep, and 37 (24.3%) MVR. Median follow-up was 28±22months. Surgery was performed during the active phase in 75.0% of patients (25.7% on an urgent basis). Compared with the MVRep group, patients in the MVR group were more frequently intravenous drug abusers (10.8% vs. 0.9%; P=0.016), had a more frequent history of rheumatic fever (13.5% vs. 0%; P=0.001), more aortic abscesses (16.7% vs. 3.5%; P=0.018), larger vegetations (16.6±8.1mm vs. 12.6±9.9mm; P=0.042) and poorer New York Heart Association status (P=0.006). Overall mortality was lower in the MVRep group than in MVR group (11.3% vs. 29.3%; P=0.018). Event-free survival was better in the MVRep group than in the MVR group in univariate analysis (hazard ratio: 2.72, 95% confidence interval: 1.34-5.52; P=0.004). Survival analysis in the propensity-matched cohort showed that MVRep was safer than MVR (log rank test: P=0.018). Multivariable analysis using the Cox proportional hazard model confirmed this finding (hazard ratio: 3.48, 95% confidence interval: 1.15-10.61; P=0.03). MVRep is feasible in most cases of NMIE and, when technically possible, should be preferred, even in urgent surgery.

Valve replacement or repair in native mitral valve infective endocarditis-Which is better? A meta-analysis and systematic review.

Native mitral valve infective endocarditis (IE) plagues patients and surgeons alike because of its high mortality and recurrence rates as well as poor prognosis. Mitral valve repair (MVP) and mitral valve replacement (MVR) are two main surgical methods. However, the question of which benefits patients more remains controversial. Thus, we conducted a meta-analysis to systematically review the two approaches, focusing on the early survival rate and long-term outcomes. A meta-analysis and systematic review were conducted using studies sourced from the PubMed, Embase, and Cochrane literature databases to compare MVP and MVR, with data extracted for baseline characteristics, mortality, survival, recurrent endocarditis, and valve reoperation. Risk ratio (RR) or hazard ratio (HR) values were calculated, and publication bias was tested. A total of 17 relevant publications with a total population of 3759 patients, with 1180 patients having undergone MVP and 2579 patients having undergone MVR, respectively, were analyzed. Patients who underwent MVP may benefit from a lower risk of early mortality (RR, 0.51; 95% confidence interval [CI], 0.39-0.66; p < .00001), a higher long-term survival rate (HR, 0.69; 95% CI, 0.58-0.81; p < .001; I2 = 0%), and a lower risk of recurrence (RR, 0.66; 95% CI, 0.40-1.09; p = .10; I2 = 0%). However, a similar risk of reoperation was observed for both groups (RR, 1.02; 95% CI, 0.36-2.91; p = .96; I2 = 43%). This meta-analysis suggests that MVP may lead to better outcomes compared to MVR. Among patients with mitral valve IE, MVP can reduce in-hospital mortality, improve long-term survival, and has a lower risk of recurrent endocarditis. As a result, MVP may be suitable as a primary treatment choice and should be considered whenever possible in most IE patients.

Minimally invasive surgery versus sternotomy in native mitral valve endocarditis: a matched comparison.

The present study compared the clinical outcomes between minimally invasive surgery (MIS) and median sternotomy (MS) in patients with native mitral valve infective endocarditis. From 2009 to 2019, a total of 154 patients with acute (n = 131, 85%) or subacute (n = 23, 15%) native mitral valve infective endocarditis were included in the study. One-to-one nearest neighbour propensity score matching considering endocarditis severity using the dedicated De Feo score and 19 other clinically relevant baseline variables resulted in a population of 39 matched pairs. The matched cohort was investigated regarding operative and postoperative outcomes. Both groups showed similar results regarding cardiopulmonary bypass time [MIS: 96 min (77-138), MS: 99 min (88-127); P = 0.780] and aortic cross-clamp time [MIS: 64 min (54-90), MS: 65 min (59-83); P = 0.563], whereas overall operative time was shorter through minimally invasive access [MIS: 138 min (112-196), MS: 187 min (175-230); P = 0.005]. Although the rate of revision for bleeding was similar in both groups [MIS: 12.8% (n = 5), MS: 10.3% (n = 4); P = 1.000], MIS was associated with fewer red blood cell unit transfusions [MIS: 1 unit (0-4), MS: 4 units (2-10); P = 0.001] and fewer fresh frozen plasma unit transfusions [MIS: 0 units (0-0), MS: 1 unit (0-5); P = 0.002]. MIS was associated with a shorter ventilation time [MIS: 708 min (429-1236), MS: 1440 min (659-4411); P = 0.024] and a lower rate of reintubation after extubation [MIS: 5.1% (n = 2), MS: 25.6% (n = 10); P = 0.021]. In patients suffering from native mitral valve infective endocarditis, MIS provides significant clinical benefits over sternotomy in selected patients. 117, 121.

Infective endocarditis and outcomes of mitral valve replacement.

We investigated the long-term outcomes of mitral valve replacement (MVR) in native mitral valve infective endocarditis (IE). Multicentre, population-based cohort register study consisted of 1233 consecutive adult patients treated with first-time MVR in Finland. Mitral valve IE was diagnosed in 170 of these patients. Propensity score matching resulted in 134 pairs with balanced baseline characteristics. The median follow-up was 6.1years. Pre-operative native mitral valve IE was associated with an increased hazard of 10-year mortality (38.8% vs 30.5%; HR 2.13; CI 1.17-3.85; P=.013) after MVR. Occurrence of major bleeding was higher in IE patients (26.0%) vs non-IE patients (23.4%) during the 10-year follow-up (HR 2.80; CI 1.01-7.77; P=.048). Hospital admission duration after MVR was longer in IE patients (median 28 vs 11days; P<.0001). Cumulative ischaemic stroke rate was similar between patient groups (12.1% in IE vs 15.1% in non-IE; P=.493). Re-sternotomy was performed in 13.4% of IE patients and 9.0% of non-IE patients (P=.261). Patients with native mitral valve IE have a higher risk of death and major bleeding after MVR than matched patients without IE. Results highlight the importance of complication prevention in these patients.

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

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

A structured approach to native mitral valve infective endocarditis: Is repair better than replacement?

OBJECTIVESMitral valve repair in native active infective endocarditis is technically challenging. The survival benefit over valve replacement is poorly established and possibly absent because of the high risk of repair failure and reoperation. In this study, we explore the results of our structured approach in these patients.METHODSBetween January 2000 and January 2017, 149 patients underwent surgery for native mitral infective endocarditis. Among them, 97 (66%) patients underwent valve repair and 52 (34%) underwent valve replacement. Our structured approach consisted of early surgery, radical resection of infected tissue, liberal use of prosthetic materials and ‘patch’ repair techniques. A critical assessment of expected repair durability was made intraoperatively and repair was not performed if concerns of long-term durability existed. To study the effects of valve repair on overall survival, landmark analysis was performed.RESULTSIn-hospital mortality was 15.4% (14 repair vs 9 replacement patients; P = 0.642). There were no residual infective endocarditis cases or early reoperations. On Cox proportional hazards analysis, valve replacement was not inferior to repair within 1-year post-surgery [hazard ratio (HR) 1.134, 95% confidence interval (CI) 0.504–2.540; P = 0.76]. Beyond 1 year post-surgery, replacement was associated with decreased survival (HR 2.534, 95% CI 1.002–6.406; P = 0.049). There were no differences in freedom from recurrent infective endocarditis (P = 0.47) and mitral valve reintervention (P = 0.52).CONCLUSIONSActive mitral valve endocarditis remains a complex disease with significant early and late morbidity and mortality. A structured approach allows valve repair in two-thirds of patients. Clinical results could be improved by focussing on early surgery, prior to extensive valve destruction, to enable durable repairs and improve late outcomes.

Corrigendum to: Outcomes of mitral valve repair in acute native mitral valve infective endocarditis [Interact CardioVasc Thorac Surg 2019; doi:10.1093/icvts/ivz187

Corrigendum to: Outcomes of mitral valve repair in acute native mitral valve infective endocarditis [Interact CardioVasc Thorac Surg 2019; doi:10.1093/icvts/ivz187

Outcomes of mitral valve repair in acute native mitral valve infective endocarditis.

Mitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis. Between January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events. The mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively. Although MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.

Early and Long-term Outcome of Mitral Valve Repair for Native Mitral Valve Infective Endocarditis

Objective: Mitral Valve Regurgitation (MR) due to infective endocarditis (IE) remains a life threatening disease, traditionally treated by prosthetic valve replacement. Since mitral valve repair (M...

A Structured Approach to Native Mitral Valve Infective Endocarditis: Is Repair Better than Replacement?

Objective: Mitral valve (MV) repair in native active infective endocarditis (IE) is technically challenging. The survival benefit over valve replacement is poorly established and could be absent be...

Native aortic versus mitral valve infective endocarditis: a nationwide registry study

BackgroundNative aortic and mitral valve infective endocarditis (AVE and MVE, respectively) are usually grouped together as left-sided native valve infective endocarditis (LNVE), while the differences between AVE and MVE have...