Objectives: In mitral valve (MV) infective endocarditis, timing of surgery and management of complex valves lesions stay two controversial topics. Early surgical approach and use of different techniques of repair characterize our last 15-years experience reported in this study.
Methods: Between 1992 and 2005, 91 patients were operated during the active phase of a MV endocarditis, 73 (80%) of them underwent MV repair and they represent the cohort of this study. Median time between diagnosis and surgery was 10 days. A variety of surgical techniques were used to restore MV competence, including biological patches of pericardium, autograft or homograft implanted as leaflet substitute in 59% of the patients. Prosthetic rings were used in 44% of the patients.
Results: Operative mortality was 17.8%. Three patients needed early MV reoperation with 1 re-repair. Mean follow-up was 6±3 years. During this period, 5 late deaths occurred; only 2 were cardiac-related. Ten years overall survival and freedom from cardiac death in hospital survivors were respectively 71±12% and 95±5 %. Five patients needed late MV reoperation with 4 re-repairs, of them one had an endocarditis recurrence. Ten years freedom from MV reoperation, replacement and endocarditis recurrence were respectively 84±12%, 96±4 % and 98±1%. At the time of follow-up, all patients were in NYHA class 1 or 2, 89% had mitral regurgitation grade ≤ 1 and 11% grade 2 on transthoracic echocardiography.
Conclusion: The present study demonstrates the feasibility, safety and durability of repairing the mitral valve in the course of an active endocarditis.