title: Outcomes of surgery in the treatment of isolated nonnative mitral valve infective endocarditis.
abstract: OBJECTIVE
  We reviewed our experience with the operative management of patients with isolated nonnative mitral valve infective endocarditis to better understand the outcome.
  
  
  METHODS
  We reviewed the records of 39 patients operated on for isolated nonnative mitral valve infective endocarditis from January 1974 to June 2009. Median age of the group was 68 years. There were 23 (59%) women. Prostheses were mechanical in 18 (46%) patients, biological in 18 (46%), and annuloplasty rings in 3 (8%). Staphylococcus was present in 22 (56%) patients. Operative indications included valve dysfunction in 26 (67%) patients and heart failure in 22 (56%).
  
  
  RESULTS
  Perivalvular abscess was present in 12 (31%) patients. Replacement valves were mechanical in 23 (59%) patients and biological in 16 (41%). Twenty (51%) patients received additional operative procedures. Treatment-related mortality occurred in 8 (21%) patients, with age being the only factor predictive of mortality (hazard ratio, 5.37). Follow-up of the survivors was 5.7 years. Six (18%) patients underwent repeat mitral valve replacement including 3 who had an annulus abscess at the initial operation and 2 who had the prosthesis sutured to the left atrial wall. There was 1 (4%) case of recurrent endocarditis in the group of 28 patients who survived more than 1 year after the incident operation. Survival at 5 years was 48% (95% confidence interval, 35%-67%).
  
  
  CONCLUSIONS
  Surgery for isolated nonnative mitral valve infective endocarditis carries increased operative risk. Aggressive debridement and reconstruction of the annulus are paramount to achieving a good outcome. Surviving patients obtain high rates of cure and freedom from recurrent infective endocarditis.
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn. Electronic address: greason.kevin@mayo.edu.
authors: Kevin L
authors: KL
authors: Greason
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Mathew
authors: M
authors: Thomas
authors: Division of Infectious Diseases, Mayo Clinic, Rochester, Minn.
authors: James M
authors: JM
authors: Steckelberg
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Richard C
authors: RC
authors: Daly
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Hartzell V
authors: HV
authors: Schaff
authors: Department of Biostatistics/Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Zhuo
authors: Z
authors: Li
authors: Division of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
authors: Joseph A
authors: JA
authors: Dearani
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003646:Debridement / Q000009:adverse effects / Q000401:mortality; D020878:Device Removal / Q000009:adverse effects / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D058386:Mitral Valve Annuloplasty / Q000009:adverse effects* / Q000295:instrumentation / Q000401:mortality; D015999:Multivariate Analysis; D016459:Prosthesis-Related Infections / Q000175:diagnosis / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000009:adverse effects / Q000401:mortality; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: 18; 22; 35