Background and Aim. The clinical benefits of mitral valve repair over replacement in the setting of mitral infective endocarditis remain not clearly established. We aim to review the clinical experience in mitral valve surgery for infective endocarditis looking at mid-term survival.
Methods. Prospectively collected data of patients who underwent cardiac surgery for infective endocarditis between 2001 and 2021 at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity score matching, including twelve preoperative variables, was performed to account for differences in patients’ profile between the repair and replacement subgroups.
Results. Propensity matching provided 87 well-matched pairs. Mean age was 60±15 years, 76% of the patients were male. Twenty-two patients (12%) had a recent cerebral event. CABG and aortic valve replacement were associated in 10% and in 38% of the cases, respectively. Patients who underwent mitral valve replacement had a higher rate of annular, commissures and bileaflet lesions. Overall in-hospital mortality was 7% with no difference between the repair and the replacement cohorts (p=0.77). Survival probabilities at 1, 5- and 10-years were 89%, 70% and 67%, respectively after mitral repair, and 88%, 76% and 62%, respectively after mitral replacement; log-rank p=0.94. Freedom from mitral intervention by any cause at 10-years was 3.3% and 8.7%, respectively after mitral repair and mitral replacement; Gray’s p=0.37.
Conclusions. Mitral valve repair was associated with acceptable in-hospital mortality and survival in a high-risk and comorbid cohort of patients with mitral valve infection. We found no difference in early, mid-term survival and mitral reoperation risk between patients who underwent repair or replacement of the mitral valve in the setting of infective endocarditis.