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You are here: Contents > 2014 > Volume 23 Number 3 May 2014 > INFECTIVE ENDOCARDITIS > Role of Mitral Valve Repair in Infective Endocarditis

Role of Mitral Valve Repair in Infective Endocarditis

Hyoung Woo Chang1, Kyung-Hwan Kim1, Ho Young Hwang1, Jun Sung Kim2

1Department of Thoracic and Cardiovascular Surgery, Seoul National University Hospital, Seoul, South Korea, 2Department of Thoracic and Cardiovascular Surgery, Seoul National University Bundang Hospital, Gyeonggi-do, South Korea

Background and aim of the study: Mitral valve reconstruction (MVP) is currently the standard treatment for degenerative mitral regurgitation (MR). However, when MR is due to infective endocarditis (IE) the range of pathophysiology present often makes any repair challenging. Hence, the authors’ clinical experience of MVP to treat MR caused by IE was analyzed.

Methods: Between September 2004 and March 2011, a total of 26 patients (20 males, six females) who had been diagnosed with MR due to IE (single surgeon, retrospective review) were operated on. Among the 26 patients (17 active, nine healed; six Carpentier type I, 20 Carpentier type II), MVP was performed in 11 patients (42.3%), of which six were active cases and five were healed. All MVP procedures included ring annuloplasty. A variety of repair techniques was used, including triangular resection (n = 3), pericardial patch reconstruction (n = 4), commissuroplasty (n = 4), artificial chordoplasty (n = 1), chordae transfer (n = 2), and secondary chordae resection (n = 1). Six of 17 patients who had a pathology favorable for repair underwent valve replacement; the etiologies were

underlying valvular disease (n = 2, rheumatic pathology), Child’s group C liver cirrhosis (n = 1), second redo sternotomy (n = 1), multivalvular disease (n = 1), and critical medical condition (n = 1, septic shock).

Results: The mean follow up duration was 35.7 months (range: 0.1-84.9 months). Among the repair group, none of the patients showed residual MR on postoperative echocardiography. There were no early or late deaths, and no patient showed newly developed MR during the follow up. Among the replacement group, three patients died of non-cardiac causes during the follow up (two early deaths and one late death).

Conclusion: MVP for MR due to IE showed successful clinical outcomes. Valve replacement was performed in some patients with a repair-favorable pathology, after taking into consideration any comorbidities. Whilst standard repair techniques were sufficient, careful decision-making was the key to achieving excellent results for MVP.

The Journal of Heart Valve Disease 2014;23:350-359

Role of Mitral Valve Repair in Infective Endocarditis

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