Mid-term Results of Mitral Valve Repair in Active Infective Endocarditis

Thitipong Tepsuwan, Pornpawee Sonthikraisitt, Chartaroon Rimsukcharoenchai, Apichat Tantraworasin, Noppon Taksaudom, Surin Woragidpoonpol, Suphachai Schuarattanapong, Weerachai Nawarawong

Chiang Mai University, Chiang Mai, Thailand

Date, time and location: 2018.05.26 15:30, Congress Hall, 2F–B

Abstract

Objective: Infective endocarditis remains an important devastating condition that needs to be addressed effectively in terms of diagnosis and treatment. Early surgery in the active phase provides better outcomes as suggested by previous reports and international guidelines. However, the feasibility and durability of mitral valve repair during this period are still questioned.

Methods: 245 patients underwent surgery in the active phase of native valve, left-sided, infective endocarditis during January 2006 to October 2017. 138 patients had mitral valve involvement and mitral valve repair could be performed in 61 patients (44.2%). Their characteristics, microbiology, valve lesions, repair techniques, and operative results were reviewed.

Results: Of 61 patients, mean age was 46 and 68.9% were male. Major causative micro-organism were Streptococci (50.8%) while culture negative were presented in 37.7%. Median time from diagnosis to surgery were 13 days while 31.1% were operated during the first week of antibiotics. Aortic valve surgery was the most common concomitant procedure (67.2%). Isolated annular dilation without leaflet involvement was presented in 39.3%. 37.7% had localised leaflet lesions while 14.8% had extensive leaflet destructions. Major techniques of reconstruction were leaflet resection and/or closure (29.5%), PTFE artificial chords (26.2%), and pericardial patch (26.2%). There were 2 operative mortality (3.3%) while mean follow-up time were 51 months with 6-year survival of 82.0%. Freedom from more than mild mitral regurgitation(MR) was 90.o%. All those who had residual MR firstly presented with extensive involvement and needed complex reconstruction.

Conclusions: The feasibility of mitral valve repair during active endocarditis is not as high as other elective conditions. However, midterm survival and freedom from residual MR are satisfactory if repair was succeeded. Surgical reconstructive experiences and expertise are crucial especially in extensive leaflet destruction.