title: Mitral valve repair provides improved outcome over replacement in active infective endocarditis.
abstract: OBJECTIVE
  Mitral repair in active infective endocarditis still remains controversial. Several studies demonstrate the feasibility of mitral repair in infective endocarditis; however, superiority of repair has never been shown. The aim of the investigation was to compare valve repair and valve replacement in respect to the extent of destruction and to analyze survival, recurrent endocarditis, and reoperation (event-free survival).
  
  
  METHODS
  Sixty-eight consecutive patients underwent surgical intervention for mitral endocarditis. Thirty-four (50%) patients had valve repair, and 34 (50%) patients had valve replacement. Leaflet destruction involving at least one mitral leaflet was present in 15 (44.1%) patients of the repair group and 11 (32.4%) patients of the replacement group. Repair of the mitral annulus with pericardium was performed in 4 (11.8%) patients in the repair group and 3 (8.8%) patients in the replacement group. Patients in both groups were similar concerning the progression of valvular destructions and comorbidities.
  
  
  RESULTS
  Hospital mortality was 11.8% (8 patients). No significant differences were found in all baseline parameters, with the exception of a higher incidence of previous septic embolism and sepsis in the repair group. Actuarial event-free survival at 1 year was 88.2% in the repair group compared with 67.7% in the replacement group, and 5-year event-free survival was 80.4% in the repair group and 54.6% in the replacement group (P = .015). Mitral valve repair remained the superior treatment regarding event-free survival in the multivariate analysis (hazard ratio, 0.33; 95% confidence interval, 0.12-0.93; P = .02).
  
  
  CONCLUSIONS
  Mitral valve repair offers excellent early and late results and is the preferable treatment option in the surgical therapy of native infective endocarditis.
authors.affiliation: Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria. elfriede.ruttmann@uibk.ac.at
authors.forename: Elfriede
authors.initials: E
authors.lastname: Ruttmann
authors.forename: Christina
authors.initials: C
authors.lastname: Legit
authors.forename: Gerhard
authors.initials: G
authors.lastname: Poelzl
authors.forename: Silvana
authors.initials: S
authors.lastname: Mueller
authors.forename: Orest
authors.initials: O
authors.lastname: Chevtchik
authors.forename: Marco
authors.initials: M
authors.lastname: Cottogni
authors.forename: Hanno
authors.initials: H
authors.lastname: Ulmer
authors.forename: Othmar
authors.initials: O
authors.lastname: Pachinger
authors.forename: Guenther
authors.initials: G
authors.lastname: Laufer
authors.forename: Ludwig C
authors.initials: LC
authors.lastname: Mueller
mesh_terms: D018572:Disease-Free Survival; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000473:pathology / Q000601:surgery*; D011183:Postoperative Complications; D011379:Prognosis; D012086:Reoperation; D015996:Survival Rate