title: Mid-term follow up of mitral valve reconstruction due to active infective endocarditis.
abstract: OBJECTIVE
  Mitral valve reconstruction in patients with acute endocarditis (AE) is a challenging operation which prompts the surgeon into immediate action. This report summarizes the mid-term results of 22 patients who required mitral valve reconstruction due to AE.
  
  
  METHODS
  Mean patient age was 46 years (range: 20-79 years); mean follow up was 46 months (range: 1-90 months). Preoperatively, >70% of patients had severe mitral regurgitation and were in NYHA functional class III. Surgical techniques used were annuloplasty (n = 16; 10 with Carpentier ring, five Wooler-Kay and one Frater); suture closure of the perforation (n = 1), patch closure of the perforation (n = 5), leaflet resection with primary closure (n = 2), leaflet resection with patch closure (n = 8), and chordal transfer (n = 3). Additional surgery included CABG (n = 3) and De Vega plasty (n = 4). Aortic valve replacement or reconstruction (n = 9) included one mechanical valve, one bioprosthesis, one reconstruction and six homografts. Patients were followed up annually in our outpatient department and/or by questionnaires.
  
  
  RESULTS
  Two patients died perioperatively due to either low output syndrome or uncontrolled sepsis. There were three reoperations; two of these were successful, and one patient subsequently died. In addition, one patient died six years after operation due to prostatic cancer, and one seven years later due to progressive heart failure. At the last follow up, 15 patients were in NYHA class I (68%) and five in class II (23%); no or only mild mitral insufficiency was seen on transthoracic echocardiography (91%). The estimated survival rate at 60 months was 87 +/- 12.7%, and 12 patients were followed up for >60 months. No incidence of recurrent valve infection occurred.
  
  
  CONCLUSIONS
  Mitral valve reconstruction in patients with AE shows a low incidence of valve-related complications with promising postoperative functional results and mid-term survival. On this basis, mitral valve reconstruction for mitral insufficiency secondary to AE may be recommended as a valve salvage treatment, when it is technically possible.
authors.affiliation: Department of Cardiothoracic Surgery, AKH Wien, Universität Wien, Vienna, Austria.
authors.forename: B K
authors.initials: BK
authors.lastname: Podesser
authors.forename: S
authors.initials: S
authors.lastname: Rödler
authors.forename: R
authors.initials: R
authors.lastname: Hahn
authors.forename: E
authors.initials: E
authors.lastname: Eigenbauer
authors.forename: M
authors.initials: M
authors.lastname: Vodrazka
authors.forename: A
authors.initials: A
authors.lastname: Moritz
authors.forename: G
authors.initials: G
authors.lastname: Laufer
authors.forename: P
authors.initials: P
authors.lastname: Simon
authors.forename: E
authors.initials: E
authors.lastname: Wolner
mesh_terms: D004697:Endocarditis, Bacterial / Q000150:complications / Q000401:mortality* / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D008944:Mitral Valve Insufficiency / Q000209:etiology / Q000601:surgery; D012086:Reoperation / Q000706:statistics & numerical data; D015996:Survival Rate; D013997:Time Factors