title: Surgery for active infective mitral valve endocarditis: a 20-year, single-center experience.
abstract: OBJECTIVE
  A retrospective analysis was conducted of the early and long-term results of mitral valve repair (MVRep) and mitral valve replacement (MVR) in patients with isolated infective mitral valve endocarditis.
  
  
  METHODS
  Between May 1986 and December 2007, a total of 1,163 patients with active infective endocarditis (AIE) were operated on. Of these patients, 497 showed an endocarditic involvement of the mitral valve. Sixty-one of these patients underwent MVRep and 219 MVR, with 24% cases of prosthetic valve endocarditis (PVE). The patients' perioperative characteristics, cumulative survival, freedom from recurrence and reoperation and independent risk factors for early mortality were analyzed. Follow up (0-21 years) was complete in 96.5% of cases; the total follow up was 348 and 810 patient-years (pt-yr) in the MVRep and MVR groups, respectively.
  
  
  RESULTS
  Typically, the MVR patients were significantly older (p < or = 0.001), preoperatively more often intubated (p = 0.008) and in cardiogenic shock (p = 0.045), and more often underwent emergency surgery (p = 0.023). MVRep was associated with a significantly better survival, with 30-day, one-, five- and 10-year survival rates of 90.1 +/- 3.9%, 83.2 +/- 4.8%, 77.0 +/- 5.7% and 60.5 +/- 8.0%, respectively (p = 0.002). Survival after MVR was significantly worse with abscess formation (p = 0.0002) and PVE (p = 0.038). Freedom from reoperation due to reinfection after 10 years was 89.4 +/- 7.0% after MVRep, with early endocarditis recurrence in two patients (3%), and 91.0 +/- 2.5% after MV, with early recurrence in four patients (2%) (p = 0.46). Multivariate analysis identified preoperative ventilation (OR = 6.3), mitral valve abscess formation (OR = 5.3), PVE (OR = 3.1) and age > or = 60 years (OR = 2.8) as independent risk factors for early mortality.
  
  
  CONCLUSIONS
  Compared to the MVRep group, patients requiring MVR had more advanced endocarditis and were more critically ill. These results suggest that the early outcome might have been improved if patients had been operated on before either heart failure or the development of septic shock. MVRep for AIE showed a low operative mortality and provided satisfactory freedom from recurrent infection and repeat operation. If all infected material could be resected such that the remaining tissue would allow the re-shaping of a competent valve, then MVRep could be performed also in infective endocarditis, in line with the general recommendations for mitral valve surgery.
authors.affiliation: Deutsches Herzzentrum Berlin, Department of Cardiothoracic and Vascular Surgery, Berlin, Germany. musci@dhzb.de
authors.forename: Michele
authors.initials: M
authors.lastname: Musci
authors.forename: Michael
authors.initials: M
authors.lastname: Hübler
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.forename: Aref
authors.initials: A
authors.lastname: Amiri
authors.forename: Julia
authors.initials: J
authors.lastname: Stein
authors.forename: Henryk
authors.initials: H
authors.lastname: Siniawski
authors.forename: Yuguo
authors.initials: Y
authors.lastname: Weng
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000401:mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D012008:Recurrence; D015996:Survival Rate