title: Outcome of surgical management for active mitral native valve infective endocarditis: a collective review of 57 patients.
abstract: OBJECTIVE
  At our institutions, mitral valve vegetation with a high risk for embolism is surgically treated as soon as possible to maintain the quality of life of patients, and valve repair has been actively performed. We reviewed the surgical outcome for active mitral infective endocarditis (AMIE) following this treatment policy.
  
  
  METHODS
  Fifty-seven patients underwent surgery for native AMIE between April 1999 and December 2012 (repair 36, replacement 21). We retrospectively investigated the risk factors for in-hospital death, the prognosis of patients with cerebral infarction, and the short- and long-term outcomes of valve repair and replacement.
  
  
  RESULTS
  The preoperative conditions and the intraoperative findings in the replacement group were more complicated. But, no significant differences were observed in in-hospital mortality, 4-year survival, or 4-year reoperation-free rate between the groups (repair 8, 88.2, and 92.4%; replacement 9, 90.5, and 94.7%, respectively). The incidence of postoperative cardiac-related events including heart failure, thromboembolism, and major bleeding was higher in the replacement group. Although our study failed to identify predictors of in-hospital mortality, uncontrolled and nosocomial infections were responsible for high in-hospital mortality of 17 and 33%, respectively. Nine patients with symptomatic non-hemorrhagic cerebral infarction underwent early surgery within 2 weeks of the onset of stroke (median maximum infarct diameter and volume: 18.2 mm and 0.72 cm(3), respectively). No patients had severe hemorrhagic conversion.
  
  
  CONCLUSIONS
  Mitral valve repair is appropriate to prevent postoperative cardiac-related events. Reducing in-hospital mortality due to uncontrolled infection remains challenging. Early surgery may be reasonable for patients with small non-hemorrhagic infarction.
authors: Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan, takashiren@yahoo.co.jp.
authors: Takashi
authors: T
authors: Miura
authors: Masayoshi
authors: M
authors: Hamawaki
authors: Shiro
authors: S
authors: Hazama
authors: Koji
authors: K
authors: Hashizume
authors: Tsuneo
authors: T
authors: Ariyoshi
authors: Mizuki
authors: M
authors: Sumi
authors: Akitsugu
authors: A
authors: Furumoto
authors: Nobuo
authors: N
authors: Saito
authors: Akira
authors: A
authors: Tsuneto
authors: Kiyoyuki
authors: K
authors: Eishi
mesh_terms: D000328:Adult; D000368:Aged; D001927:Brain Diseases / Q000209:etiology; D002097:C-Reactive Protein / Q000032:analysis; D006348:Cardiac Surgical Procedures; D003428:Cross Infection / Q000401:mortality; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000382:microbiology / Q000401:mortality / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000382:microbiology / Q000601:surgery; D011379:Prognosis; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D002097:C-Reactive Protein