MITRAL VALVE REPLACEMENT OR REPAIR IN INFECTIVE ENDOCARDITIS: ROLE OF THE ISOLATED PATHOGENS ON MORTALITY AND EARLY OR LATE RELAPSE RATE

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Abstract Background Mitral valve repair (MVr) is unquestionably superior to mitral valve replacement (MVR) in non–infective settings. European Society of Cardiology (ESC) and American Association for Thoracic Surgery guidelines recommend repair oxver replacement where possible even for endocarditis. Despite these recommendations, mitral valve repair rates are still low in this population. The aims of this study were to compare outcome of patients with infective endocarditis undergoing mitral valve repair compared to those undergoing mitral valve replacement and to investigate the impact of microbial etiology on patient outcomes. Methods The study retrospectively analyzed 215 patients undergoing valve replacement or repair for endocarditis from January 2010 to December 2022 in a large cardiosurgical center. The primary outcome was a composite outcome of early (30–days) all–cause mortality and/or endocarditis relapse, while the secondary outcome was medium/long term (1 year) all–cause mortality. Results A total of 215 patients with either active or healed mitral valve endocarditis were included in our study: 154 (71.6%) underwent mitral valve replacement and 61 (28.4%) underwent mitral valve repair. Patients with multi–valve disease were also included (97, 45.1%). 188 patients (87.4%) were operated in the active phase (80.9% as an urgent/ emergency). In–hospital mortality was observed in 5 patients (8.2%) in the repair group and 19 (12.3%) in the replacement group. Endocarditis relapse occurred in 6 patients (9.8%) in the repair group after a median time of 3.8 months and in 5 (3.3%) in the replacement group after 11.8 months. (p=0.356). Median follow up was 12.6 months. Early and medium survival rates in the propensity–adjusted cohort showed no difference between mitral valve repair and replacement, but resulted to be influenced by the microbial etiology with the worst prognosis for both Staphylococcus aureus and Coagulase–negative Staphylococci. Conclusions The choice of surgical treatment strategy in infective endocarditis had no effect on major postoperative complications, mortality, relapse or medium/long–term survival. Mitral valve repair seems to have a major incidence of relapse even though non statistically significant, probably due to the low number of events. Both Staphylococcus aureus and Coagulase–negative Staphylococci are a risk factor for early mortality and relapse rate. Mitral valve repair for endocarditis should be pursued, if feasible.

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