Management of commissural lesions in native mitral valve endocarditis: long-term results of valve repair and partial homograft replacement.
OBJECTIVE
Commissural lesions in the context of native mitral valve endocarditis are a technically challenging condition for conservative surgery. Herein are reported the authors' 10-year results for mitral valve repair (MVRep) or partial homograft replacement (PHR) performed in this setting.


METHODS
Data were reviewed from 19 consecutive patients who underwent MVRep using either Carpentier's technique (n = 14) or PHR (n = 5) for endocarditis at the authors' institution between 1989 and 1994.


RESULTS
There was one operative death (5%; 95% CI 0-15.5%). Two reoperations were performed in each subgroup for recurrence of endocarditis (n = 2) and mitral valve failure (n = 2). The 10-year survival rate and freedom from mitral valve reoperation were 95% (95% CI 84-100%) and 78% (95% CI 59-97%), respectively. At 10 years, 13 (93%) surviving and non-reoperated patients were in good functional status (NYHA class I-II), and 14 (100%) were in sinus rhythm. Although echocardiographic results were excellent in the MVRep group, all PHR patients had moderate or severe mitral valve dysfunction.


CONCLUSIONS
Commissural reconstruction using Carpentier's techniques demonstrated excellent long-term results in patients with native mitral valve endocarditis. In contrast, the results for PHR were rather disappointing.
Zegdi
Rachid
R
Université René Descartes, Paris V, France. rzegdi@hotmail.com
Khabbaz
Ziad
Z
Flecher
Erwan
E
Latrémouille
Christian
C
Noghin
Milena
M
Chauvaud
Sylvain
S
Gerota
Jean
J
Deloche
Alain
A
Carpentier
Alain
A
Fabiani
Jean-Noël
JN
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D008945:Mitral Valve Prolapse / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies; D013534:Survival; D016019:Survival Analysis; D013997:Time Factors; D014184:Transplantation, Homologous; D016896:Treatment Outcome