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J Am Coll Cardiol, 2004; 43:386-392, doi:10.1016/j.jacc.2003.09.034 © 2004 by the American College of Cardiology Foundation |
* 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.
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