Surgical interventions of isolated active mitral valve endocarditis

Hsiu An Lee, Chun Yu Lin, Yung Chang Chen, Shao Wei Chen, Yu Yun Nan, Kuo Sheng Liu, Meng Yu Wu, Yu Sheng Chang, Jaw Ji Chu, Pyng Jing Lin, Feng Chun Tsai*

*Corresponding author for this work

Research output: Contribution to journalJournal Article peer-review

7 Scopus citations

Abstract

The feasibility and durability of mitral valve (MV) repair in active infective endocarditis (IE) has been reported, but proper management of perioperative neurological complications and surgical timing remains uncertain and may crucially affect the outcome. In this single-center retrospective observational study, patients who underwent isolated MV surgery for active native IE in our institution between August 2005 and August 2015 were reviewed and analyzed. Patients who were operated on for healed IE or who required combined procedures were excluded from this study. A total of 71 patients were enrolled in the study with a repair rate of 53.5% (n = 38). Isolated posterior leaflet lesion was found in 15 patients (21%) and was related to higher reparability (86.7%, P = .004). The overall in-hospital mortality was 10 (14.1%): 3 (7.9%) in the repair group and 7 (21.2%) in replacement group (P = .17). Prognosis was not related to age, preoperative renal function, cerebral emboli, or duration of antibiotics. The only significant predictor was postoperative intracranial hemorrhage (ICH) [odds ratio 14.628 (1.649-129.78), P = .04]. At a mean follow-up period of 43.1 months, neither recurrent endocarditis nor late cardiac death was observed in both groups. Surgical timing and procedural options of MV surgery in active native IE did not make any difference, but occurrence of ICH after surgery jeopardized the final outcome. Routine preoperative brain imaging to detect silent ICH or mycotic aneurysm and aggressive treatment of these lesions may prevent catastrophe and optimize the results.

Original languageEnglish
Article numbere0054
JournalMedicine (United States)
Volume97
Issue number11
DOIs
StatePublished - 01 03 2018
Externally publishedYes

Bibliographical note

Publisher Copyright:
© Copyright 2018 the Author(s). Published by Wolters Kluwer Health, Inc.

Keywords

  • infective endocarditis
  • intracranial hemorrhage
  • mitral valve repair
  • neurologic complications

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