title: Endocarditis after interventional repair of the mitral valve: Review of a dilemma.
abstract: BACKGROUND
  The MitraClip procedure can be an alternative treatment option for patients with high surgical risk for whom surgical treatment is contraindicated. Patients with prosthetic material have an increased risk for infective endocarditis.
  
  
  OBJECTIVE
  Incidence, treatment and outcome of patients with endocarditis after interventional mitral valve repair are not known.
  
  
  METHODS
  We searched for articles using PubMed using the terms "interventional mitral valve repair", "mitraclip" and "endocarditis". We have also searched for case reports in major congresses. Furthermore, we report two cases.
  
  
  RESULTS
  Four cases of IE after MitraClip were found in addition to our cases. The leading cause is a bacterial infection, typically with staphylococcal bacteria. Approximately two thirds of these patients underwent surgery. Short-term outcome seems to be reasonable for these patients. During the early postoperative period and if Staphylococcus aureus can be cultivated mortality seems to be significantly elevated.
  
  
  CONCLUSIONS
  IE after MitraClip procedure is a dilemma. While surgical bail-out seems to be the favorable treatment option, patients were rejected conventional surgery in first place due to their high operative risk. Best treatment recommendation must be made on an individual basis. Predisposing factors should be conscientiously addressed prior to the procedure.
authors.affiliation: Department of Cardiology, University Hospital of Giessen, Giessen, Germany. Electronic address: niklas.boeder@innere.med.uni-giessen.de.
authors.forename: Niklas F
authors.initials: NF
authors.lastname: Boeder
authors.affiliation: Department of Cardiology, University Hospital of Giessen, Giessen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Dörr
authors.affiliation: Department of Cardiology, University Hospital of Giessen, Giessen, Germany.
authors.forename: Johannes
authors.initials: J
authors.lastname: Rixe
authors.affiliation: Department of Cardiology, University Hospital of Giessen, Giessen, Germany.
authors.forename: Kay
authors.initials: K
authors.lastname: Weipert
authors.affiliation: Department of Cardiology, University Hospital of Giessen, Giessen, Germany.
authors.forename: Timm
authors.initials: T
authors.lastname: Bauer
authors.affiliation: Department of Cardiology, University Hospital of Giessen, Giessen, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Bayer
authors.affiliation: Department of Cardiology, University Hospital of Giessen, Giessen, Germany.
authors.forename: Christian W
authors.initials: CW
authors.lastname: Hamm
authors.affiliation: Department of Cardiology, University Hospital of Giessen, Giessen, Germany.
authors.forename: Holger M
authors.initials: HM
authors.lastname: Nef
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D006348:Cardiac Surgical Procedures / Q000379:methods; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D008944:Mitral Valve Insufficiency / Q000382:microbiology / Q000601:surgery; D013211:Staphylococcus aureus / Q000302:isolation & purification; D016896:Treatment Outcome; D008297:Male; D000369:Aged, 80 and over
keywords: Endocarditis; Mitraclip; Mitral valve repair