Late Outcomes of Mitral Valve Repair in Infective Endocarditis Compared to Repair of Degenerative Mitral Valve Without Endocarditis - The 65th Annual Conference of the Israel Heart Society & The Israel Society of Cardiothoracic Surgery, 24-25 April 2018

Hillit Cohen Cardiothoracic Surgery, Tel Aviv University, Tel Aviv, Israel, Israel Leonid Sterink Cardiothoracic Surgery, Tel Aviv University, Tel Aviv, Israel, Israel Alexander Lipey Cardiothoracic Surgery, Tel Aviv University, Tel Aviv, Israel, Israel Alexander Kogan Cardiothoracic Surgery, Tel Aviv University, Tel Aviv, Israel, Israel Sergei Amontz Cardiothoracic Surgery, Tel Aviv University, Tel Aviv, Israel, Israel Raphael Kupershtein Cardiothoracic Surgery, Tel Aviv University, Tel Aviv, Israel, Israel Shani Levin Cardiothoracic Surgery, Tel Aviv University, Tel Aviv, Israel, Israel Ehud Raanani Cardiothoracic Surgery, Tel Aviv University, Tel Aviv, Israel, Israel

Background:

Mitral valve (MV) repair, when possible, is considered to be an attractive option in the presentation of MV infective endocarditis (IE). While the advantage of MV repair over replacement is well known, clinical and echocardiographic long term outcome of repair in patients with IE is yet to be established.

Methods:

From 2004 to 2017, 796 patients with degenerative mitral valve underwent mitral valve repair in our department. 80 patients had a medical history of IE (IE group), of which 32 (54%) presented with acute endocarditis, 12 (15%) subacute, and 23 (29%) remote endocarditis.

The remaining 716 patients (non-IE group) underwent MV repair due to a degenerative myxomatous disease with various clinical manifestations.

All patients were prospectively followed and long term clinical and echocardiographic outcomes were compared and analyzed.

Results:

At a mean FU of 64 months (range 64-/+45) the overall late mortality rate (all causes) in the IE group was 10% versus 7% in the non-IE group (p = 0.257). By Kaplan Meier, no differences were found in survival rate between both groups across the follow-up period (p=0.188). Late stroke was 0% in the IE group versus 4% in the non-IE group (p=0.16). Clinical assessment following New York Heart Association classification revealed freedom from function class III-IV of 95% in the IE group versus 91% in the non-IE group (p= 0.68). Late echocardiography revealed freedom from moderate or severe MR to be 88% versus 85% in the IE group and non- IE group respectively (p=0.5).

Freedom from reoperation was 91% versus 93% in the SBE and non-SBE group respectively (p=0.65).

Conclusions:

Mitral Valve repair in degenerative MV presenting with IE is associated with good clinical and echocardiographic late outcomes, comparable to the clinical results of degenerative MR without IE. These findings lead to believe this should indeed be the treatment of choice whenever feasible.