Mitral valve repair for active culture positive infective endocarditis

• Published in: Heart (British Cardiac Society) Vol. 92; no. 3; pp. 361 - 363
• Main Authors: Doukas, G, Oc, M, Alexiou, C, Sosnowski, A W, Samani, N J, Spyt, T J
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.03.2006; BMJ; BMJ Publishing Group LTD; BMJ Group
• Subjects: active endocarditis; Adolescent; Adult; Aged; Aged, 80 and over; Anti-Bacterial Agents - therapeutic use; Antibiotics; Biological and medical sciences; Cardiology; Cardiology. Vascular system; Cardiovascular Medicine; Echocardiography; Endocardial and cardiac valvular diseases; endocarditis; Endocarditis, Bacterial - surgery; Female; Heart; Hospitals; Humans; Infections; infective endocarditis; Male; Medical sciences; Middle Aged; mitral regurgitation; mitral valve; Mitral Valve - surgery; Mitral Valve Insufficiency - microbiology; Mitral Valve Insufficiency - surgery; Mortality; New York Heart Association; NYHA; Postoperative Care - methods; Stroke; Surgery; Treatment Outcome; valve repair; Mitral valve; Cardiac valvular disease; Endocardial disease; Endocarditis; Cardiovascular disease; Circulatory system; Cardiology; Mitral valve disease; Phlebology; Culture
• ISSN: 1355-6037; 1468-201X
• DOI: 10.1136/hrt.2004.059063

Objective: To describe the clinical and echocardiographic outcome after mitral valve (MV) repair for active culture positive infective MV endocarditis. Patients and methods: Between 1996 and 2004, 36 patients (mean (SD) age 53 (18) years) with positive blood culture up to three weeks before surgery (or positive culture of material removed at operation) and intraoperative evidence of endocarditis underwent MV repair. Staphylococci and streptococci were the most common pathogens. All patients had moderate or severe mitral regurgitation (MR). Mean New York Heart Association (NYHA) class was 2.3 (1.0). Follow up was complete (mean 38 (19) months). Results: Operative mortality was 2.8% (one patient). At follow up, endocarditis has not recurred. One patient developed severe recurrent MR and underwent valve replacement and one patient had moderate MR. There were two late deaths, both non-cardiac. Kaplan-Meier five year freedom from recurrent moderate to severe MR, freedom from repeat operation, and survival were 94 (4)%, 97 (3)%, and 93 (5)%, respectively. At the most recent review the mean NYHA class was 1.17 (0.3) (p < 0.0001). At the latest echocardiographic evaluation, left atrial diameters, left ventricular end diastolic diameter, and MV diameter were significantly reduced (p < 0.05) compared with preoperative values. Conclusions: MV repair for active culture positive endocarditis is associated with low operative mortality and provides satisfactory freedom from recurrent infection, freedom from repeat operation, and survival. Hence, every effort should be made to repair infected MVs and valves should be replaced only when repair is not possible.