Background : We reviewed our experience with reconstructive mitral valve surgery for active infective endocarditis.
Methods : Between May 1992 and August 1999, 65 pts were operated for active infective endocarditis of the mitral valve. Twenty-one pts had a valve replacement while 46 had a valve repair. In these pts, the indication for surgery was repeated embols in 14 pts (3 CVA), persistent sepsis in 17 and heart failure in 15. The endocarditis concerned the mitral valve only in 26 pts, the mitral and the aortic valve in 16 pts and 4 pts had an abscess of the fibrous skeleton of the heart. Thirty-six pts had a classical mitral valve repair following Carpentier techniques. Eight pts had leaflet destruction necessitating more complex reconstructive surgery: 3 pts had a mitral homograft, 3 a tricuspid autograft and 2 reconstruction with autologuous pericardium. Six patients, in whom the mitro-aortic continuity was destroyed, necessitated a reconstruction of the fibrous skeleton with bovine pericardial patches.
Results : There were two hospital deaths. Two patients needed reopening for bleeding. Three patients had recurrence of mitral valve regurgitation in the first three post-operative months and underwent a successful redo mitral valve repair. The mean follow-up was 40.3 ± 12 months. There were 4 late deaths (2 were cardiac related). Only one patient suffered an early prosthetic valve endocarditis on a Carpentier ring. The patient was reoperated at 6 months and the ring was replaced with a pericardial patch.
Conclusion : Mitral valve reconstructive surgery is feasible in the majority of the cases of active infective endocarditis of the mitral valve. These techniques will provide the best resistance to early and late infection while preserving ventricular function.