Extending the scope of mitral valve repair in active endocarditis.
OBJECTIVE
During the last 2 decades, we have applied a repair-oriented surgical approach to patients with active mitral valve endocarditis. We retrospectively analyzed the long-term outcomes with this repair-oriented approach.


METHODS
Between 1991 and 2010, 137 patients underwent operation for active mitral valve endocarditis; of these, 109 patients (80%) had mitral valve repair and represent the study cohort. Repair techniques without patch extension (no-patch techniques) include triangular or quadrangular resection (n = 49), sliding plasty (n = 24), neochordae (n = 18), chordal transfer (n = 12), and others (n = 5). Repair techniques using patch extension (patch techniques) included pericardium (n = 42), tricuspid autograft (n = 8), flip-over technique (n = 7), and partial mitral valve homograft (n = 5). Patches were used in 67 patients (61%). Ring annuloplasty was performed in 60 patients, and a pericardial band was used in 13 patients. Clinical and echocardiographic follow-up were performed. Median follow-up was 48 months.


RESULTS
Hospital mortality was 16%. At 8 years, overall survival was 62% ± 10% with no differences between patients with or without patch repair (P = .5). Freedom from mitral valve repair failure was 81% ± 14% in patients with patch repair and 90% ± 10% in patients without patch repair (P = .09). The rate of thromboembolic or bleeding event was 1% per patient-year, and the rate of endocarditis recurrence was 0.3% per patient-year. Univariable predictors of mortality were age more than 70 years (P < .0001), perivalvular abscess (P = .002), diabetes mellitus (P = .0002), and renal failure (P = .04). Predictors of repair failure were renal failure (P = .035) and perivalvular abscess (P = .033).


CONCLUSIONS
In active mitral valve endocarditis, a repair-oriented surgical approach achieves a reparability rate of 80% with acceptable morbidity and good long-term results. The use of patch techniques offers a durability rate that approximates the rate obtained with the no-patch techniques.
Division of Cardiothoracic and Vascular Surgery, Université Catholique de Louvain, Cliniques Universitaires Saint-Luc, Brussels, Belgium. laurent.dekerchove@uclouvain.be
Laurent
L
de Kerchove
Joel
J
Price
Saadallah
S
Tamer
David
D
Glineur
Mona
M
Momeni
Philippe
P
Noirhomme
Gebrine
G
ElKhoury
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium; D004696:Endocarditis / Q000401:mortality / Q000601:surgery*; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult