IS THERE AN ADVANTAGE TO REPAIRING INFECTED MITRAL-VALVES

Background. The therapy for native mitral valve endocarditis is in evo lution. Antibiotics have significantly improved survival rates, but pa tients with complications csf endocarditis may require surgical treatm ent. Methods. Between January 1985 and December 1995, 146 patients und erwent surgical therapy (repair or replacement) for native mitral valv e endocarditis. All patients had documented bacterial endocarditis. Un ivariate and multivariate analyses were performed to determine predict ors of hospital death, long-term event-free survival, and probability of repair. Patients were evaluated in three groups: all patients, pati ents with acute endocarditis, and patients with chronic endocarditis. Results. There were ten hospital deaths (6.8%), Patients undergoing re pair had a lower hospital mortality rate (p = 0.008) then those having replacement. Event-free survival was improved after mitral valve repa ir in the overall group (p = 0.02) and in the group with healed (chron ic) endocarditis (p = 0.05). Although the acute endocarditis group dem onstrated an improved event-free survival rate after mitral valve repa ir versus replacement (74% versus 20% at 6 years), this did not reach statistical significance. Conclusions. We conclude that mitral valve r epair is preferable to mitral valve replacement when possible, in pati ents with complications of endocarditis, as repair results in a lower hospital mortality and an improved long-term survival. (C) 1997 by The Society of Thoracic Surgeons.