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Outcome of surgical management for active mitral native valve infective endocarditis: a collective review of 57 patients

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Abstract

Objective

At our institutions, mitral valve vegetation with a high risk for embolism is surgically treated as soon as possible to maintain the quality of life of patients, and valve repair has been actively performed. We reviewed the surgical outcome for active mitral infective endocarditis (AMIE) following this treatment policy.

Methods

Fifty-seven patients underwent surgery for native AMIE between April 1999 and December 2012 (repair 36, replacement 21). We retrospectively investigated the risk factors for in-hospital death, the prognosis of patients with cerebral infarction, and the short- and long-term outcomes of valve repair and replacement.

Results

The preoperative conditions and the intraoperative findings in the replacement group were more complicated. But, no significant differences were observed in in-hospital mortality, 4-year survival, or 4-year reoperation-free rate between the groups (repair 8, 88.2, and 92.4 %; replacement 9, 90.5, and 94.7 %, respectively). The incidence of postoperative cardiac-related events including heart failure, thromboembolism, and major bleeding was higher in the replacement group. Although our study failed to identify predictors of in-hospital mortality, uncontrolled and nosocomial infections were responsible for high in-hospital mortality of 17 and 33 %, respectively. Nine patients with symptomatic non-hemorrhagic cerebral infarction underwent early surgery within 2 weeks of the onset of stroke (median maximum infarct diameter and volume: 18.2 mm and 0.72 cm3, respectively). No patients had severe hemorrhagic conversion.

Conclusion

Mitral valve repair is appropriate to prevent postoperative cardiac-related events. Reducing in-hospital mortality due to uncontrolled infection remains challenging. Early surgery may be reasonable for patients with small non-hemorrhagic infarction.

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Acknowledgments

We are grateful to Dr. Yohei Tateishi, Department of Neurology, Nagasaki University Hospital, for his cooperation in the treatment of infective endocarditis patients with brain complications, and express special thanks to Dr. Seiji Matsukuma and Dr. Ichiro Matsumaru for providing the valuable data.

Conflict of interest

The authors report no conflicts of interest.

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Authors and Affiliations

  1. Department of Cardiovascular Surgery, Nagasaki University Hospital, 1-7-1 Sakamoto, Nagasaki, Nagasaki, 852-8501, Japan

    Takashi Miura, Koji Hashizume & Kiyoyuki Eishi

  2. Department of Cardiovascular Surgery, National Hospital Organization Nagasaki Medical Center, Nagasaki, Japan

    Masayoshi Hamawaki, Tsuneo Ariyoshi & Mizuki Sumi

  3. Department of Cardiovascular Surgery, Sasebo General Hospital, Nagasaki, Japan

    Shiro Hazama

  4. Department of Infectious Disease, Nagasaki University Hospital, Nagasaki, Japan

    Akitsugu Furumoto & Nobuo Saito

  5. Department of Cardiology, Nagasaki University Hospital, Nagasaki, Japan

    Akira Tsuneto

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  1. Takashi Miura
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  2. Masayoshi Hamawaki
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Correspondence to Takashi Miura.

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Miura, T., Hamawaki, M., Hazama, S. et al. Outcome of surgical management for active mitral native valve infective endocarditis: a collective review of 57 patients. Gen Thorac Cardiovasc Surg 62, 488–498 (2014). https://doi.org/10.1007/s11748-014-0377-y

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  • DOI: https://doi.org/10.1007/s11748-014-0377-y

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