CLINICAL RESEARCH: VALVULAR HEART DISEASE
Contemporary results of mitral valve repair for infective endocarditis
Bernard Iung, MD*,*,
Juliette Rousseau-Paziaud, MD ,
Bertrand Cormier, MD*,
Eric Garbarz, MD ,
Olivier Fondard, MD*,
Eric Brochet, MD*,
Christophe Acar, MD ,
Jean-Paul Couëtil, MD||,
Ulrik Hvass, MD|| and
Alec Vahanian, MD*
* Cardiology Department, Bichat Hospital, AP-HP, Paris, France
Cardiology Department, Henri Mondor Hospital, Paris, France
Cardiology Department, Tenon Hospital, Paris, France
Cardiac Surgery Department, La Pitié-Sapetrière Hospital, Paris, France
|| Cardiac Surgery Department, Bichat Hospital, Paris, France
Manuscript received April 8, 2003;
revised manuscript received July 4, 2003,
accepted September 8, 2003.
* Reprint requests and correspondence: Dr. Bernard Iung, Cardiology Department, Bichat Hospital, 46 rue Henri Huchard, 75018 Paris, France.
bernard.iung{at}bch.ap-hop-paris.fr
OBJECTIVES: We sought to evaluate the feasibility and immediate and late results of mitral valve repair (MVRep) for acute and healed endocarditis.
BACKGROUND: Improvements in techniques of MVRep have extended its feasibility in complex lesions, but experience with endocarditis is limited.
METHODS: Among 78 patients operated on for mitral endocarditis between 1990 and 1999, 63 underwent MVRep. The repair was performed for acute endocarditis in 25 patients (40%) at a median of 20 days after the onset of treatment and in 38 patients (60%) for healed endocarditis after a median of 11 months.
RESULTS: Repair of the mitral valve was feasible in 63 patients (81%). This repair involved annuloplasty in 61 patients (97%), valve resection in 49 (78%), shortening or transposition of chordae in 29 (46%), suture of perforation in 18 (29%), a pericardial patch in 12 (19%), and a partial mitral homograft in 7 (11%). Associated procedures were aortic valve replacement in 11 patients, bypass grafting in 3, and tricuspid repair in 2. Early complications were two deaths (3.2%), one re-operation for severe mitral regurgitation and one re-operation for subsequent aortic endocarditis. The seven-year rate of event-free survival was 78 ± 6% in the global series. Multivariate predictors of event-free survival were hypertension (p < 0.006) and intervention for acute endocarditis (p < 0.026). Five-year survival rates were 96 ± 4% after MVRep for acute endocarditis and 91 ± 5% for healed endocarditis.
CONCLUSIONS: Mitral valve repair is frequently feasible and gives good results in patients with infective endocarditis. Patients operated on for acute endocarditis experience more events during follow-up than those operated on after healed endocarditis but have excellent late survival.
|
Abbreviations and Acronyms
| | LV | = left ventricle/ventricular | | MR | = mitral regurgitation | | MVRep | = mitral valve repair | | NYHA | = New York Heart Association | | RR | = relative risk | | TEE | = transesophageal echocardiography |
|
This article has been cited by other articles:
|
|
|
|
 
E. Shang, G. N. Forrest, T. Chizmar, J. Chim, J. M. Brown, M. Zhan, G. H. Zoarski, B. P. Griffith, and J. S. Gammie
Mitral Valve Infective Endocarditis: Benefit of Early Operation and Aggressive Use of Repair.
Ann. Thorac. Surg.,
June 1, 2009;
87(6):
1728 - 1734.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
O. A. Araji, J. M. Barquero, M. Almendro, M. A. Gutierrez, M. Garcia-Borbolla, C. J. Velazquez, and C. A. Infantes
Replacement of A2 and a3 by pericardium due to endocarditis of the anterior leaflet of the mitral valve.
Ann. Thorac. Surg.,
February 1, 2009;
87(2):
653 - 654.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
A. M. Sheikh, A. M. Elhenawy, M. Maganti, S. Armstrong, T. E. David, and C. M. Feindel
Outcomes of surgical intervention for isolated active mitral valve endocarditis.
J. Thorac. Cardiovasc. Surg.,
January 1, 2009;
137(1):
110 - 116.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
2006 WRITING COMMITTEE MEMBERS, R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease): Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
Circulation,
October 7, 2008;
118(15):
e523 - e661.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
2008 Focused Update Incorporated Into the ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Endorsed by the Society of Cardiovascular Anesthesiologists, Society for Cardiovascular Angiography and Interventions, and Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
September 23, 2008;
52(13):
e1 - e142.
[Full Text]
[PDF]
|
|
|
|
|
|
|
M. A. Smith and D. D. Yuh
Bioprosthetic Mitral Valve Implantation for Active Mitral Valve Endocarditis in Third Degree Thorax Burn
Ann. Thorac. Surg.,
May 1, 2008;
85(5):
1791 - 1792.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
C. Acar
Early surgery in mitral valve endocarditis: it is sometimes too early
Eur. J. Cardiothorac. Surg.,
December 1, 2007;
32(6):
947 - 947.
[Full Text]
[PDF]
|
|
|
|
|
|
|
L. de Kerchove, J.-L. Vanoverschelde, A. Poncelet, D. Glineur, J. Rubay, F. Zech, P. Noirhomme, and G. El Khoury
Reconstructive surgery in active mitral valve endocarditis: feasibility, safety and durability
Eur. J. Cardiothorac. Surg.,
April 1, 2007;
31(4):
592 - 599.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Gammie, S. M. O'Brien, B. P. Griffith, T. B. Ferguson, and E. D. Peterson
Influence of Hospital Procedural Volume on Care Process and Mortality for Patients Undergoing Elective Surgery for Mitral Regurgitation
Circulation,
February 20, 2007;
115(7):
881 - 887.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. H.H. Feringa, L. J. Shaw, D. Poldermans, S. Hoeks, E. E. van der Wall, R. A.E. Dion, and J. J. Bax
Mitral Valve Repair and Replacement in Endocarditis: A Systematic Review of Literature
Ann. Thorac. Surg.,
February 1, 2007;
83(2):
564 - 570.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Guidelines for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
e1 - e148.
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. O. Bonow, B. A. Carabello, K. Chatterjee, A. C. de Leon Jr, D. P. Faxon, M. D. Freed, W. H. Gaasch, B. W. Lytle, R. A. Nishimura, P. T. O'Gara, et al.
ACC/AHA 2006 Practice Guidelines for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (Writing Committee to Revise the 1998 Guidelines for the Management of Patients With Valvular Heart Disease) Developed in Collaboration With the Society of Cardiovascular Anesthesiologists Endorsed by the Society for Cardiovascular Angiography and Interventions and the Society of Thoracic Surgeons
J. Am. Coll. Cardiol.,
August 1, 2006;
48(3):
598 - 675.
[Full Text]
[PDF]
|
|
|
|
|
|
|
H. H.H. Feringa, J. J. Bax, P. Klein, R. J.M. Klautz, J. Braun, Ernst. E. van der Wall, D. Poldermans, and R. A.E. Dion
Outcome after mitral valve repair for acute and healed infective endocarditis
Eur. J. Cardiothorac. Surg.,
March 1, 2006;
29(3):
367 - 373.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S A Livesey
Mitral valve reconstruction in the presence of infection
Heart,
March 1, 2006;
92(3):
289 - 290.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G. Habib
Management of infective endocarditis
Heart,
January 1, 2006;
92(1):
124 - 130.
[Full Text]
[PDF]
|
|
|
|
|
|
|
J. S. Gammie, S. M. O'Brien, B. P. Griffith, and E. D. Peterson
Surgical Treatment of Mitral Valve Endocarditis in North America
Ann. Thorac. Surg.,
December 1, 2005;
80(6):
2199 - 2204.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. Aubert, T. Barreda, C. Acar, P. Leprince, N. Bonnet, R. Ecochard, A. Pavie, and I. Gandjbakhch
Mitral valve repair for commissural prolapse: surgical techniques and long term results
Eur. J. Cardiothorac. Surg.,
September 1, 2005;
28(3):
443 - 447.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
E. Ruttmann, C. Legit, G. Poelzl, S. Mueller, O. Chevtchik, M. Cottogni, H. Ulmer, O. Pachinger, G. Laufer, and L. C. Mueller
Mitral valve repair provides improved outcome over replacement in active infective endocarditis
J. Thorac. Cardiovasc. Surg.,
September 1, 2005;
130(3):
765 - 771.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
G Nadji, J P Remadi, F Coviaux, A Ali Mirode, A Brahim, M Enriquez-Sarano, and C Tribouilloy
Comparison of clinical and morphological characteristics of Staphylococcus aureus endocarditis with endocarditis caused by other pathogens
Heart,
July 1, 2005;
91(7):
932 - 937.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
R. Zegdi, M. Debieche, C. Latremouille, D. Lebied, C. Chardigny, J.-M. Grinda, S. Chauvaud, A. Deloche, A. Carpentier, and J.-N. Fabiani
Long-Term Results of Mitral Valve Repair in Active Endocarditis
Circulation,
May 17, 2005;
111(19):
2532 - 2536.
[Abstract]
[Full Text]
[PDF]
|
|
|
|
|
|
|
S. H. Rahimtoola
The year in valvular heart disease
J. Am. Coll. Cardiol.,
January 4, 2005;
45(1):
111 - 122.
[Full Text]
[PDF]
|
|
|
|
