title: The advantage of repair of mitral valve in acute endocarditis.
abstract: OBJECTIVE
  Mitral valve repair offers a survival benefit compared with valve replacement in surgery for non-infectious mitral regurgitation. It is unclear whether repair offers an advantage for patients undergoing mitral valve surgery for active endocarditis. Morbidity and mortality (early and late) and event-free survival were compared between the repair and replacement groups.
  
  
  METHODS
  Between September 1986 and July 1999, 44 patients with acute native mitral valve endocarditis underwent surgery; 28 patients had valve replacement, and 16 underwent repair. Nine patients had complex repairs including replacement of a portion of the leaflet with prosthetic patch, placement of artificial chordae, resection of a portion of both leaflets, and/or reconstruction of a commissure. The remainder had simple repairs.
  
  
  RESULTS
  Preoperative characteristics and indications for surgery between the two groups were similar. There were six in-hospital (21%) and six late cardiac deaths (21%) in the valve replacement group, but no early deaths or late cardiac deaths in the repair group (p <0.05). Independent risk factors for early and late death were need for associated procedures (p <0.03) and mitral valve replacement (p <0.05). Additional risk factors for late death were diabetes mellitus (p = 0.005) and hemodynamic instability as an indication for surgery (p = 0.047). Five patients undergoing valve replacement required reoperation due to recurrent endocarditis, compared with none in the repair group (p = 0.065). Mean follow up was 39+/-33 months in the repair group, and 57+/-51 months in the replacement group.
  
  
  CONCLUSIONS
  Early and late mortality and event-free survival were better in patients undergoing mitral valve repair compared with replacement for acute endocarditis. Valve repair should be carried out whenever possible in this patient group.
authors.affiliation: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, MN 55902, USA.
authors.forename: Leonid
authors.initials: L
authors.lastname: Sternik
authors.forename: Kenton J
authors.initials: KJ
authors.lastname: Zehr
authors.forename: Thomas A
authors.initials: TA
authors.lastname: Orszulak
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Mullany
authors.forename: Richard C
authors.initials: RC
authors.lastname: Daly
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
mesh_terms: D000208:Acute Disease; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D006348:Cardiac Surgical Procedures / Q000379:methods*; D002315:Cardiopulmonary Bypass; D002648:Child; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000382:microbiology* / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D016896:Treatment Outcome