title: Mitral valve infective endocarditis: benefit of early operation and aggressive use of repair.
abstract: BACKGROUND
  In-hospital mortality rates for left-sided infective endocarditis (IE) exceed 20%. We investigated the outcomes of an aggressive approach to mitral valve IE that emphasizes early surgical intervention and preferential performance of mitral valve repair.
  
  
  METHODS
  We reviewed 89 consecutive operations in 87 patients for native mitral valve IE at a single institution from 2002 to 2007. Operations occurred promptly after completion of preoperative studies. Independent risk factors for death were investigated using multivariable logistic regression.
  
  
  RESULTS
  Mitral valve repair was accomplished in 56 of 89 patients (63%). Perioperative mortality was 4.4% (n = 4). Survival rates at 1 and 5 years were 89.9% (80 of 89) and 82.0% (73 of 90). There was a survival benefit for repair vs replacement at 1 (p = 0.03) and 5 years (p = 0.0017). Repair vs replacement (odds ratio [OR], 0.2; 95% confidence interval [CI], 0.06 to 0.72), diabetes (OR, 4.43; 95% CI, 1.18 to 16.66), and renal failure (OR, 3.65; 95% CI, 1.3 to 12.91) were independent risk factors for late mortality. Among 59 patients with active IE, preoperative head computed tomography (CT) showed 29 (49%) had abnormalities, including 12 (41%) with intracerebral hemorrhage. The median interval was 4 days from admission to operation. The rate of permanent postoperative stroke was 1.1% (1 of 89).
  
  
  CONCLUSIONS
  These results support early surgical therapy for mitral valve IE. Head CT abnormalities do not warrant delay of operation. Mitral valve repair was associated with a long-term survival advantage compared with valve replacement.
authors.affiliation: Division of Cardiac Surgery, Emergency Department, University of Maryland Medical Center, Baltimore, Maryland 21201, USA.
authors.forename: Eric
authors.initials: E
authors.lastname: Shang
authors.forename: Graeme N
authors.initials: GN
authors.lastname: Forrest
authors.forename: Timothy
authors.initials: T
authors.lastname: Chizmar
authors.forename: Jimmy
authors.initials: J
authors.lastname: Chim
authors.forename: James M
authors.initials: JM
authors.lastname: Brown
authors.forename: Min
authors.initials: M
authors.lastname: Zhan
authors.forename: Gregg H
authors.initials: GH
authors.lastname: Zoarski
authors.forename: Bartley P
authors.initials: BP
authors.lastname: Griffith
authors.forename: James S
authors.initials: JS
authors.lastname: Gammie
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004697:Endocarditis, Bacterial / Q000150:complications / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000150:complications / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve; D012189:Retrospective Studies; D013997:Time Factors; D055815:Young Adult