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Original Articles: Adult Cardiac

Long-Term Outcome of Mitral Valve Repair for Infective Endocarditis

^a Department of Cardiovascular Surgery, Sakakibara Heart Institute, Tokyo, Japan
^b Department of Biostatistics and Epidemiology, Yokohama City University Medical Center, Yokohama, Japan

Accepted for publication May 13, 2009.

^_* Address correspondence to Dr Shimokawa, Department of Cardiovascular Surgery, Sakakibara Heart Institute, 3-16-1 Asahicho, Fuchu City, Tokyo, 183-0003, Japan (Email: tshimokawa-circ{at}umin.ac.jp).

Presented at the Forty-fifth Annual Meeting of The Society of Thoracic Surgeons, San Francisco, CA, Jan 26–28, 2009.

Background: In patients with mitral endocarditis, reconstruction of the damaged mitral valve (MV) is still challenging, and its durability remains unknown. We evaluated the long-term outcomes of MV repair for mitral regurgitation (MR) in patients with infective endocarditis.

Methods: From 1991 to 2006, 633 patients had MV repair for MR caused by leaflet prolapse: 78 had endocarditis (active in 14, healed in 64) and 555 had degenerative disease. Durability was assessed by reoperation and recurrent MR.

Results: The overall hospital mortality rate was 1.0% (endocarditis 0% vs degenerative 1.1%; p = 0.99). The 10-year survival and freedom from reoperation were 91.1 ± 1.6% and 92.2 ± 1.7%, respectively, with no differences between endocarditis and degenerative disease. Older age, New York Heart Association class III or IV, impaired ventricular function, and no use of annuloplasty were independent predictors of all-cause death. Freedom from moderate or severe MR was 99.8 ± 0.2% at 2 weeks, 91.9 ± 1.5% at 5 years, and 83.3 ± 2.3% at 10 years, for all patients and did not differ between groups at 10 years (p = 0.388). Anterior leaflet prolapse, preoperative atrial fibrillation, and no annuloplasty were independent predictors of recurrent MR. In endocarditis patients, recurrent MR was mainly caused by leaflet thickening and calcification, but not by recurrence of endocarditis.

Conclusions: MV repair for endocarditis is associated with low operative mortality and morbidity, and its long-term durability is comparable with that of repair for degenerative disease. This study suggests that a degenerative process causes late failure after MV repair for endocarditis.