General Thoracic and Cardiovascular Surgery

, Volume 62, Issue 8, pp 488–498 | Cite as

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

  • Takashi Miura
  • Masayoshi Hamawaki
  • Shiro Hazama
  • Koji Hashizume
  • Tsuneo Ariyoshi
  • Mizuki Sumi
  • Akitsugu Furumoto
  • Nobuo Saito
  • Akira Tsuneto
  • Kiyoyuki Eishi
Original Article

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.

Keywords

Active infective endocarditis Mitral valve repair Mitral valve replacement Brain complications 

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Copyright information

© The Japanese Association for Thoracic Surgery 2014

Authors and Affiliations

  • Takashi Miura
    • 1
  • Masayoshi Hamawaki
    • 2
  • Shiro Hazama
    • 3
  • Koji Hashizume
    • 1
  • Tsuneo Ariyoshi
    • 2
  • Mizuki Sumi
    • 2
  • Akitsugu Furumoto
    • 4
  • Nobuo Saito
    • 4
  • Akira Tsuneto
    • 5
  • Kiyoyuki Eishi
    • 1
  1. 1.Department of Cardiovascular SurgeryNagasaki University HospitalNagasakiJapan
  2. 2.Department of Cardiovascular SurgeryNational Hospital Organization Nagasaki Medical CenterNagasakiJapan
  3. 3.Department of Cardiovascular SurgerySasebo General HospitalNagasakiJapan
  4. 4.Department of Infectious DiseaseNagasaki University HospitalNagasakiJapan
  5. 5.Department of CardiologyNagasaki University HospitalNagasakiJapan

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