Mid-term follow up of mitral valve reconstruction due to active infective endocarditis

Background and aim of the study: Mitral valve reconstruction in patients wi th acute endocarditis (AE) is a challenging operation which prompts the sur geon into immediate action. This report summarizes the mid-term results of 22 patients who required mitral valve reconstruction due to AE. Methods: Mean patient age was 46 years (range: 20-79 years); mean follow up was 46 months (range: 1-90 months). Preoperatively, >70% of patients had s evere mitral regurgitation and were in NYHA functional class III. Surgical techniques used were annuloplasty (n = 16; 10 with Carpentier ring, five Wo oler-Kay and one Frater); suture closure of the perforation (n = 1), patch closure of the perforation (n = 5), leaflet resection with primary closure (n = 2), leaflet resection with patch closure (n = 8), and chordal transfer (n = 3). Additional surgery included CABG (n = 3) and De Vega plasty (n = 4). Aortic valve replacement or reconstruction (n = 9) included one mechani cal valve, one bioprosthesis, one reconstruction and six homografts. Patien ts were followed up annually in our outpatient department and/or by questio nnaires. Results: Two patients died perioperatively due to either low output syndrom e or uncontrolled sepsis. There were three reoperations; two of these were successful, and one patient subsequently died. In addition, one patient die d six years after operation due to prostatic cancer, and one seven years la ter due to progressive heart failure. At the last follow up, 15 patients we re in NYHA class I (68%) and five in class II (23%); no or only mild mitral insufficiency was seen on transthoracic echocardiography (91%). The estima ted survival rate at 60 months was 87 +/- 12.7%, and 12 patients were follo wed up for >60 months. No incidence of recurrent valve infection occurred. Conclusion: Mitral valve reconstruction in patients with AE shows a low inc idence of valve-related complications with promising postoperative function al results and mid-term survival. On this basis, mitral valve reconstructio n for mitral insufficiency secondary to AE may be recommended as a valve sa lvage treatment, when it is technically possible.