Mitral Valve Repair Improves Long-Term Cardiac Functional Outcome in Patients with Infective Endocarditis

Abstract

Manabu Shiraishi*, Kengo Teshima, Hiroki Arai, Shigeto Tokunaga, Naoyuki Kimura and Atsushi Yamaguchi

Objectives: The aim of the investigation was to compare long-term clinical and echocardiographic outcomes of Mitral Valve Repair (MVRep) against those of Mitral Valve Replacement (MVR) performed for Infective Endocarditis (IE).

Background: Several observational studies have suggested better survival after performance of MVRep vs. MVR in patients with IE. However, factors affecting the feasibility of MVRep and its effects on late-period cardiac function remain unknown.

Methods: This retrospective study included 101 consecutive patients referred to our institution between April 1990 and December 2022 and treated for mitral valve IE (63 by MVR and 38 by MVRep). Perioperative variables and long-term outcomes were compared between the 2 patient groups.

Results: Active IE, heart failure and a large area of Leaflet destruction were found to be independent predictive factors for selection of MVRep. In-hospital death occurred in 2 (2.0%) cases (2 MVR group patients), and 12 (11.9%) patients (11 MVR group patients and MVRep group patient) died during follow-up. Higher 10-year survival (94.7% vs. 75.2%) and event-free 10-year survival (72.2% vs. 66.8%) were observed in the MVR group vs. the MVRep group). In addition, re-intervention (7.9% vs. 21.1%), MR recurrence (13.2% vs. 21.1%) and Atrial Fibrillation (AF) (5.3% vs. 33.3%) rates were lower following MVRep. Echocardiographic follow-up revealed significant reverse remodeling and an improved trans-mitral pressure gradient in the MVRep group.

Conclusion: MVRep for mitral valve IE is feasible and yields good perioperative outcomes. The procedure appears to suppress AF by effecting significant reductions in left ventricular dimensions and left atrial load.