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Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry


Cuerpo, Gregorio P; Valerio, M; Pedraz, A; Rodríguez-Abella, H; Mestres, Carlos A; Obrador, Eduardo Quintana; González-Calle, Antonio; Rodríguez Álvarez, Regino; García, Patricia Muñoz; Bouza, Emilio; GAMEs Study Group (2019). Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry. General Thoracic and Cardiovascular Surgery, 67(7):585-593.

Abstract

INTRODUCTION
Infective endocarditis (IE) still carries high morbidity and mortality and frequently requires surgery. The benefit of mitral valve repair (MVr) in the setting of IE is yet to be proven. The goal of this study was to assess the results of MVr in patients with IE after a minimum follow-up of 1 year.
METHODS
This study is based on a Spanish nationwide prospective registry that included patients operated on for native mitral valve IE. The collaborating Institutions pooled their pre-, peri-, and postoperative data into the database of the GAMES group [Grupo de Apoyo al Manejo de la EndocarditiS (Group for support and management of infective endocarditis)].
RESULTS
Data from 27 hospitals were recorded and 3524 cases of active IE identified between 2008 and 2016. There were 1513 cases of mitral IE, of which 898 involved native valves. Of these, 437 patients underwent surgical treatment, and 369 completed the 1-year follow-up. The valve was repaired in 68 cases (18.4%). Preoperative groups were comparable (EuroSCORE MVr 7.7 vs MVR 8.0; p = ns). Mortality in the repair group was inferior to that in the replacement group (16.2% vs 27.2%, p = 0.058). At 1 year, mortality remained higher in the replacement group: 3.7% vs 2.9%. Relapse of the infection was slightly more frequent in the repair group (7.1% vs 3.7%; p = ns), although this did not lead to higher rates of reintervention (MVr/MVR: 2.9% vs 4.9%).
CONCLUSION
MVr is an attractive option for specific patients with IE and does not seem to negatively impact on relapses.

Abstract

INTRODUCTION
Infective endocarditis (IE) still carries high morbidity and mortality and frequently requires surgery. The benefit of mitral valve repair (MVr) in the setting of IE is yet to be proven. The goal of this study was to assess the results of MVr in patients with IE after a minimum follow-up of 1 year.
METHODS
This study is based on a Spanish nationwide prospective registry that included patients operated on for native mitral valve IE. The collaborating Institutions pooled their pre-, peri-, and postoperative data into the database of the GAMES group [Grupo de Apoyo al Manejo de la EndocarditiS (Group for support and management of infective endocarditis)].
RESULTS
Data from 27 hospitals were recorded and 3524 cases of active IE identified between 2008 and 2016. There were 1513 cases of mitral IE, of which 898 involved native valves. Of these, 437 patients underwent surgical treatment, and 369 completed the 1-year follow-up. The valve was repaired in 68 cases (18.4%). Preoperative groups were comparable (EuroSCORE MVr 7.7 vs MVR 8.0; p = ns). Mortality in the repair group was inferior to that in the replacement group (16.2% vs 27.2%, p = 0.058). At 1 year, mortality remained higher in the replacement group: 3.7% vs 2.9%. Relapse of the infection was slightly more frequent in the repair group (7.1% vs 3.7%; p = ns), although this did not lead to higher rates of reintervention (MVr/MVR: 2.9% vs 4.9%).
CONCLUSION
MVr is an attractive option for specific patients with IE and does not seem to negatively impact on relapses.

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Additional indexing

Item Type:Journal Article, refereed, original work
Communities & Collections:04 Faculty of Medicine > University Hospital Zurich > Clinic for Vascular Surgery
Dewey Decimal Classification:610 Medicine & health
Scopus Subject Areas:Health Sciences > Surgery
Health Sciences > Pulmonary and Respiratory Medicine
Health Sciences > Cardiology and Cardiovascular Medicine
Uncontrolled Keywords:Cardiac surgery Infectious endocarditis Mitral valve Reparation Mitral valve replacement
Language:English
Date:1 July 2019
Deposited On:14 Mar 2019 13:50
Last Modified:29 Jul 2020 09:35
Publisher:Springer
ISSN:1863-6705
OA Status:Closed
Publisher DOI:https://doi.org/10.1007/s11748-019-01063-0
PubMed ID:30666586

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