Why the study?
Factors contributing to successful mitral valve repair and the impact of complex techniques on durability for active infective endocarditis of the mitral valve required clarification.
Does mitral valve repair compared to replacement improve clinical outcomes in patients with active infective endocarditis of the mitral valve?
Does mitral valve repair compared to replacement improve clinical outcomes in patients with active infective endocarditis of the mitral valve?
Mitral valve repair for active infective endocarditis yields similar mortality and complication rates to replacement but is associated with a higher rate of reintervention, particularly when complex repair techniques are used.
May warrant caution selecting repair in active mitral IE; leaves open optimal strategy without randomized data.
BACKGROUND AND AIM: To determine the factors contributing to successful mitral valve repair (MVP) and to discuss the effect of complex techniques on the durability of MVP for active infective endocarditis (IE) affecting the mitral valve. METHODS: One hundred and eighty-seven patients were enrolled; 39.6% underwent mitral valve replacement (MVR) and 60.4% underwent MVP. We used logistic regression to identify influencing factors of the choice of surgical technique. The results were compared between groups and subgroups after propensity score matching (PSM). RESULTS: Risk factors for MVR included poor valve quality (odds ratio [OR] 23.3, p = .001), a large defect after debridement (OR 16.4, p < .001), and heavy valve infection (OR 3.7, p = .027). After PSM, we did not find a significant difference in the frequency of major postoperative complications or the in-hospital or postdischarge death rate. The reintervention rate for MVP was significantly higher than that for MVR (p = .047). Subgroup analysis found a significant relationship between the use of a complex repair technique and the need for reoperation (p = .020). CONCLUSIONS: The choice of valve repair or replacement for patients with active IE affecting the mitral valve was influenced by the intraoperative characteristics of the infected valve rather than the severity of systemic infection or overall health status. The choice of surgical treatment strategy had no effect on major postoperative complications, in-hospital mortality, or medium-term survival. However, the medium-term durability of MVP was poorer than that of MVR. The use of the patch technique for free margins or extensive leaflet defects was associated with a need for reintervention.
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Liu et al. (2022) studied this question.
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