Results of mitral valve repair versus mitral valve replacement for isolated active infective mitral valve endocarditis: 20-year single center experience

Objective: We retrospectively compared early and long-term results of mitral valve repair (MVRep) and mitral valve replacement (MVR) in patients with isolated infective mitral valve endocarditis (MVE). Methods: Between 04/1986 and 12/2006, 1143 infective endocarditis operations were performed including 470 cases of MVE. Fity-nine of these patients (39 men, median 49 years) received MVRep and 194 MVR (124 men, median 57 years) due to isolated MVE. Probability of survival, freedom from recurrence and reoperation were calculated using Kaplan-Meier and Chi2-test to identify predictors. Follow-up (3 months-19.6 years) was completed in all survivors with 306 and 719 patients years in the MVRep and MVR group. Results: Compared to the MVRep group, MVR patients were significantly older, preoperatively significantly more often intubated, in more advanced cardiac decompensation and more often underwent emergency operation. MVRep patients had significantly more preoperative septic cerebral embolism. MVRep was associated with significantly better survival than MVR: 30-day, 1, 5, 10 and 15 year survival rate was 91.4%±3.6%, 84.0%±5.0%, 76.6%±6.1%, 62.4%±8.2% and 62.4%±8.2% compared to 80.1%±2.9%, 66.4%±3.5%, 52.8%±3.9%, 39.8%±4.5% and 36.9%±5.0% (p=0.0050). Freedom from MV reoperation due to failure of reconstruction at 1, 5 and 10 years was 86.6%±5.0%, 84.4%±5.4%, and 79.1%±7.2%. Early re-endocarditis occurred in 2/59 (3.3%) after MVRep and 5/194 (2.5%) after MVR. Conclusions: MVRep for MVE shows much better early and long-term survival than MVR. It should be performed when all infected material can be resected and the remaining tissue allows re-shaping of a competent valve.