Conservative operation for infective endocarditis of the mitral valve.
BACKGROUND
Subvalvular preservation is necessary to maintain left ventricular function, but accidental retention of infected tissue could cause postoperative endocarditis.


METHODS
We examined 71 consecutive patients who underwent operation for mitral endocarditis. Endocarditis was uncontrolled and active in 24 patients, partially treated (unfinished antibiotic course) in 17, and healed in 30.


RESULTS
Valves were repaired in 17% versus 59% versus 63% and replaced with subvalvular preservation in 25% versus 6% versus 3% of the uncontrolled active, partially treated, and healed groups, respectively. Thirty-day mortality was 29% versus 0% versus 3.3% (p=0.003), total mortality was 46% versus 18% versus 17% (p=0.035), and complications-related mortality was 38% versus 11% versus 13% (p=0.054), respectively. There was a trend toward lower complications-related mortality with subvalvular preservation than without. Postoperative endocarditis occurred in 3 of 30 patients without and 1 of 41 patients with subvalvular preservation.


CONCLUSIONS
Postoperative mortality in uncontrolled active mitral endocarditis remains high, but results are good with partially treated or healed endocarditis. Subvalvular preservation improves outcome, does not increase postoperative endocarditis rates, and should be performed whenever feasible.
Lee
E M
EM
Regional Cardiac Unit, Papworth Hospital, Cambridge, United Kingdom.
Shapiro
L M
LM
Wells
F C
FC
D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000925:Anticoagulants / Q000009:adverse effects; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000209:etiology; D003646:Debridement; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D004617:Embolism / Q000209:etiology; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery*; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000382:microbiology / Q000601:surgery; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D011183:Postoperative Complications; D019106:Postoperative Hemorrhage / Q000139:chemically induced; D011475:Prosthesis Failure; D012008:Recurrence; D012086:Reoperation; D013203:Staphylococcal Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D013290:Streptococcal Infections / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000601:surgery; D015996:Survival Rate; D016896:Treatment Outcome; D016277:Ventricular Function, Left / Q000502:physiology
D000900:Anti-Bacterial Agents; D000925:Anticoagulants