Published in:
01-08-2014 | Original Article
Outcome of surgical management for active mitral native valve infective endocarditis: a collective review of 57 patients
Authors:
Takashi Miura, Masayoshi Hamawaki, Shiro Hazama, Koji Hashizume, Tsuneo Ariyoshi, Mizuki Sumi, Akitsugu Furumoto, Nobuo Saito, Akira Tsuneto, Kiyoyuki Eishi
Published in:
General Thoracic and Cardiovascular Surgery
|
Issue 8/2014
Login to get access
Abstract
Objective
At our institutions, mitral valve vegetation with a high risk for embolism is surgically treated as soon as possible to maintain the quality of life of patients, and valve repair has been actively performed. We reviewed the surgical outcome for active mitral infective endocarditis (AMIE) following this treatment policy.
Methods
Fifty-seven patients underwent surgery for native AMIE between April 1999 and December 2012 (repair 36, replacement 21). We retrospectively investigated the risk factors for in-hospital death, the prognosis of patients with cerebral infarction, and the short- and long-term outcomes of valve repair and replacement.
Results
The preoperative conditions and the intraoperative findings in the replacement group were more complicated. But, no significant differences were observed in in-hospital mortality, 4-year survival, or 4-year reoperation-free rate between the groups (repair 8, 88.2, and 92.4 %; replacement 9, 90.5, and 94.7 %, respectively). The incidence of postoperative cardiac-related events including heart failure, thromboembolism, and major bleeding was higher in the replacement group. Although our study failed to identify predictors of in-hospital mortality, uncontrolled and nosocomial infections were responsible for high in-hospital mortality of 17 and 33 %, respectively. Nine patients with symptomatic non-hemorrhagic cerebral infarction underwent early surgery within 2 weeks of the onset of stroke (median maximum infarct diameter and volume: 18.2 mm and 0.72 cm3, respectively). No patients had severe hemorrhagic conversion.
Conclusion
Mitral valve repair is appropriate to prevent postoperative cardiac-related events. Reducing in-hospital mortality due to uncontrolled infection remains challenging. Early surgery may be reasonable for patients with small non-hemorrhagic infarction.