MITRAL-VALVE RECONSTRUCTION FOR ACTIVE AND HEALED ENDOCARDITIS

Background Mitral valve reconstruction rather than replacement for mit ral insufficiency offers a number of well-accepted benefits. However, the feasibility and results of reconstruction for endocarditis remain largely unknown. Methods and Results We reviewed 22 consecutive patien ts referred to the Thoracic Surgical Service at the University of Mich igan from January 1, 1991, through October 1, 1995, who underwent mitr al valve reconstruction for mitral insufficiency caused by isolated mi tral valve endocarditis. Mean age, preoperative ejection fraction, and New York Heart Association (NYHA) functional class were 53+/-15 years , 54+/-12%, and 3.2+/-0.8, respectively. Seven patients had early oper ation because of septic embolization, persistent infection, or refract ory heart failure. Fifteen were cured of infection and were operated o n for progressive symptomatic heart failure and left ventricular dilat ion. Preoperative transesophageal echocardiograms demonstrated severe mitral insufficiency in 20 patients. Valvular pathology noted at opera tion included annular (6 patients) or leaflet calcification (2), chord al rupture (13), leaflet vegetations (11), annular abscess (3), annula r dilation (18), flail leaflet (12), leaflet prolapse (17), chordal sh ortening (1), and mitral stenosis (1). Mitral valve reconstruction inc luded debridement of infected tissue and implantation of an annuloplas ty ring (20 of 22 patients), as well as other complex techniques. Post repair transesophageal echocardiograms demonstrated mild mitral insuff iciency in 6 patients and none in 16 patients. There were no operative or in-hospital deaths. Mean follow-up was 20+/-14 months. One late de ath occurred at 30 months. At follow-up, 90% of surviving patients wer e in NYHA functional class I or II. Conclusions Mitral valve reconstru ction for active or healed endocarditis can be performed with low oper ative morbidity and mortality and yields excellent functional results. Although longer-term follow-up is mandatory, these data support stron g consideration of mitral valve reconstruction rather than mitral valv e replacement for mitral insufficiency secondary to endocarditis.