Surgical results of active infective native mitral valve endocarditis: repair versus replacement

Objective: The current study compared clinical outcomes after mitral valve repair or replacement in patients with active infective endocarditis involving only the native mitral valve. Methods: From January 1994 to December 2009, 102 patients were identified with active infective native mitral valve endocarditis. Mitral valve repair (MVP) was performed in 41 patients and mitral valve replacement (MVR) in 61 patients. The mean age was 34.4 ± 16.9 years in the MVP group and 43.1 ± 14.9 years in the MVR group (p = 0.007). The composite end points of cardiac death and cardiac-related morbidities were compared in these two groups using the inverse-probability-of-treatment-weighted method. The median follow-up time was 4.7 years (range, 0.1–15.8) and follow-up was possible in 100 (98%) patients. Results: There were three in-hospital deaths (2.9%), all in MVR patients (p = 0.272). The mean cardiopulmonary bypass time and aortic cross-clamping time were 111.4 ± 34.7 min and 72.7 ± 23.7 min in the MVP group and 101.1 ± 42.9 min and 62.9 ± 26.9 min in the MVR group (p = 0.204, p = 0.062). The 1-, 5-, and 10-year survival rates were 97.5%, 97.5%, and 81.1%, respectively, in the MVP group and 90%, 85.8%, and 85.8%, respectively, in the MVR group (p = 0.316). Actuarial event-free survival at 1, 5, and 10 years was 92.7%, 89.5%, and 72.2% in the MVP group, and 94.8%, 81.0%, and 77.3% in the MVR group (p = 0.787), respectively. Conclusions: The present study showed that postoperative long-term survival and event-free survival in patients with active infective endocarditis of the native mitral valve were not statistically significantly different regardless of whether patients underwent MVP or MVR.     

Bartonella haenselae infective endocarditis following transcatheter edge‐to‐edge mitral valve repair: A case report

Infective endocarditis following a Mitraclip procedure might be an under‐recognized complication. We describe the case of infective endocarditis by Bartonella henselae as a late complication in a patient with a previously implanted MitraClip system for mitral valve repair. Due to the severity of infection, surgical treatment was performed despite the high preoperative surgical risk, but recurrence of endocarditis of the biological valve implanted occurred. Although infection with Bartonella is known as a possible source of endocarditis, it has never been described before in relation to failed MitraClip therapy.     

Mitral valve repair for infective endocarditis

OBJECTIVE: This study investigated the feasibility of mitral valve (MV) repair in patients with active or healed infective endocarditis (IE) with mitral regurgitation and evaluated effects on left ventricular (LV) function and structure. METHODS: Subjects comprised 19 patients who underwent MV operations for IE between December 2004 and September 2007. MV repair was performed for acute IE in 10 of 15 patients (67%) and for healed IE in 4 of 4 patients (100%). RESULTS: No early or late postoperative deaths were encountered. One patient underwent redo MV repair owing to severe mitral regurgitation 1 month postoperatively. Postoperative echocardiography after MV repair demonstrated less than trivial (acute IE in seven, healed IE in three) or mild (acute IE in three, healed IE in one) mitral regurgitation. In patients with MV replacement, the postoperative left atrial dimension (LAD) was decreased (51.5 +/- 39.2 vs. 39.2 +/- 1.9 mm, P = 0.007); however LV end-diastolic dimension (LVDD) and LV end-systolic dimension were unchanged. In patients with MV repair, LVDD (57.5 +/- 6.5 vs. 46.0 +/- 5.6 mm, P < 0.001), LV end-systolic dimension (36.1 +/- 5.2 vs. 32.4 +/- 6.2 mm, P = 0.04), LAD (43.1 +/- 8.1 vs. 33.6 +/- 7.7 mm, P = 0.003) were reduced. Postoperative ejection fraction (55.3 +/- 13.5% vs. 41.8% +/- 10.0%, P = 0.03) and fraction shortening (30.1% +/- 9.2% vs. 20.7% +/- 5.5%, P = 0.03) were better in patients with MV repair than those with MV replacement. CONCLUSIONS: MV repair is feasible in patients with both active and healed IE. MV repair preserves better LV function and structure postoperatively.     

二尖瓣修复术治疗感染性心内膜炎所致二尖瓣反流患者

目的探讨二尖瓣修复及置换术对感染性心内膜炎所致二尖瓣反流患者的疗效。 方法选取2014年1月至2016年1月于淄博市中心医院就诊的126例感染性心内膜炎所致二尖瓣反流患者为研究对象,根据治疗过程中手术方式不同分为研究组和对照组（各63例）,研究组患者采取二尖瓣修复术进行治疗,对照组患者采取二尖瓣置换术进行治疗。详细记录入组患者的气管插管时间、入住重症加强护理病房（ICU）时间、感染发生率、手术患者病死率、住院天数、住院花费等;记录患者心脏超声检查结果：左心室射血分数、左心室舒张末期直径、左心室收缩末期直径、左心房直径及二尖瓣反流得分,并记录随访指标。 结果与对照组患者相比,研究组患者气管插管时间[（16.48 ± 8.06）h]、入住ICU时间[（2.12 ± 0.86）h]、术后病死率（1.59%）、住院时间[（22.46 ± 10.34）d]、栓塞发生率（4.76%）以及住院花费[（10.63 ± 3.57）万元]差异均有统计学意义（t = 1.35、P = 0.04,t = 3.68、P = 0.02,χ² = 4.67、P = 0.01,t = 4.03、P = 0.01,χ² = 1.69、P = 0.04,t = 3.06、P = 0.03）;研究组患者术后左心室射血分数[（49.06 ± 10.24）%]、左心房直径[（43.25 ± 8.98）mm]和二尖瓣反流得分[（1.12 ± 0.31）分]均小于对照组患者,左心室舒张末期直径[（52.46 ± 7.42）mm]和左心室收缩末期直径[（39.70 ± 8.09）mm]均大于对照组患者,差异均有统计学意义（t = 1.23、2.84、3.89、1.34、2.01,P = 0.04、0.02、0.01、0.03、0.02）。随访显示,研究组患者左心室射血分数[（61.38 ± 8.61）%]大于对照组患者（t = 5.31、P = 0.01）,左心室舒张末期直径[（48.69 ± 9.57）mm]和随访病死率（4.76%）均小于对照组,差异有统计学意义（t = 3.24、P = 0.02,χ² = 2.91,P = 0.03）。单因素方差分析显示入住ICU时间、插管时间和心功能衰竭史均为感染性心内膜炎患者手术死亡危险因素（t = 2.34、P = 0.01,t = 1.09、P = 0.03,χ² = 1.61、P = 0.02）。 结论二尖瓣修复术对感染性心内膜炎所致二尖瓣反流疗效和预后较好,能够缩短患者住院时间和降低入院费用。     

静脉注射吸毒者感染性心内膜炎的外科治疗

目的 探讨静脉注射毒品所致感染性心内膜炎的外科治疗经验.方法 17例患者静脉注射毒品史2～10年,均有心脏瓣膜赘生物;其中三尖瓣赘生物并关闭不全16例,二尖瓣赘生物并关闭不全合并室间隔缺损1例,术前血培养阳性8例.三尖瓣置换术8例,三尖瓣成形术8例,二尖瓣置换同期室间隔缺损修补术1例.术后平均随访(44.7 ±19.1)月.结果 全部患者治愈出院,心功能明显改善,随访期间抗凝不当致大咯血1例,三尖瓣重度返流1例.结论 外科手术修复受累瓣膜或置换瓣膜是治疗静脉吸毒性感染性心内膜炎的有效手段.     

Aortic valve perforation due to latent infective endocarditis

A 64-year-old man underwent aortic valve, replacement for aortic regurgitation. The aortic valve was perforated in the noncoronary cusp. Pathological findings showed that the perforation probably occurred due to infective endocarditis. However, the patient had no obvious inflammatory signs preoperatively, to suggest latent infective endocarditis.     

Splenic abscess associated with active infective endocarditis

Splenic abscess is a rare complication in infective endocarditis. Here, we present two cases of splenic abscess associated with active infective endocarditis. Body computed tomography before emergency valvular surgery revealed abscess in the spleen. In case 1, the abscess was localized within the spleen; splenectomy and valve replacement were performed through the same median skin incision. In case 2, the splenic abscess was diagnosed as ruptured; valve replacement was performed, followed by splenectomy through a separate skin incision. No recurrence of infection occurred after surgery in either case. In surgical treatment for active infective endocarditis, body computed tomography is essential to diagnose splenic abscess preoperatively. If there is an abscess, then splenectomy and valvular surgery should be performed simultaneously to prevent reinfection after valvular surgery. The approach to the spleen should be individualized according to the extension of the abscess.     

Double valve replacement for infective endocarditis in a hemodialysis patient: A case report

A 57-year-old man who was in end stage renal failure underwent an aortic and mitral valve replacement for the progression of cardiac dysfunction, secondary to Staphylococcus aureus infective endocarditis. Cardiac surgery was performed using a Hemo-Concentrator during cardiopulmonary bypass, 82 months following the initiation of hemodialysis. This is the second report in the literature of a successful double valve replacement for infective endocarditis and congestive heart failure in a chronic hemodialysis patient.     

Surgical treatment of right-sided infective endocarditis

Objective

Right-sided infective endocarditis is increasing because of increasing prevalence of predisposing conditions, and the role and outcomes of surgery are unclear. We therefore investigated the surgical outcomes for right-sided infective endocarditis.

The successful surgical repair of a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis: Report of a case

We report herein the case of a 42-year-old man who developed a left ventricular-right atrial communication and aneurysm of the mitral valve caused by infective endocarditis, which was associated with aortic regurgitation. Based on the findings of congestive heart failure, prolongation of the PR interval, and the added threat of rupture of the mitral aneurysm, surgical treatment was decided upon as the best course of action. The aortic and mitral valves were replaced with prosthetic mechanical valves, and the septal communication was simultaneously closed with a patch. The patient's postoperative course was uneventful and he has been in good health since. Thus, we believe that aggressive surgical intervention for complicated lesions such as those seen in our patient may be life-saving, even in the presence of inflammatory signs.     

Optimizing outcomes in infective endocarditis: A comprehensive literature review

Background: Despite being rare, infective endocarditis (IE) is a life-threatening disease with poor prognosis. New diagnostic and therapeutic strategies are emerging; however, predisposing factors and microbiology of the disease are also changing with time. Because of this, there has been a lack of reduction in the disease's incidence and new challenges for clinicians have arisen such as an increasingly aging population and growing antimicrobial resistance. Aims: In this paper, we aim to provide an overview of the changing trends in IE, current diagnosis, and management strategies, as well as the emerging role of the infective endocarditis teams in the care of patients with this disease. Materials & Methods: A comprehensive electronic search was done utilizing PubMed, Ovid, SCOPUS, Embase and google scholar. The search terms included ‘Endocarditis’, ‘IE’, ‘Infection’, ‘Vegetation’, ‘Duke criteria’, ‘native valve infection’, ‘prosthetic valve’, ‘valve infection’, ‘endocarditis outcome’ and ‘endocarditis bacteriology’. The references of the identified articles were then searched for any potential articles that can be included. The inclusion criteria were any article that discussed the evidence behind incidence and management of IE including the role of endocarditis team. The exclusion criteria were case reports, expert opinion, and editorials. Results: All the relevant findings are summarized in specified tables and within appropriate sections. Discussion: It is vital to determine the current trends in the epidemiology and microbiology of the condition so that the diagnostic threshold can be adapted, to identify new at-risk groups and achieve an accelerated evaluation strategy that allows for earlier diagnosis and treatment. Conclusion: Management of IE can benefit from the input of different specialties, such as cardiology, cardiothoracic surgery, infectious disease, and microbiology. Therefore, adopting a multidisciplinary approach towards treatment is crucial to reduce morbidity and mortality from preventable complications of this pathology.     

Spontaneous splenic rupture following mitral valve replacement for infective endocarditis successfully managed with splenic artery embolisation

We report a rare case of infective endocarditis complicated by postoperative splenic rupture. A patient underwent urgent mitral valve replacement for infective endocarditis believed to be associated with a recent spinal surgical intervention. The patient developed haemodynamic compromise on the third day postoperatively. Computed tomography showed a splenic rupture as the cause. The patient underwent emergency radiological intervention with coil embolization avoiding the need for a splenectomy and was discharged home.     

Successful valve repair for congenital bicuspid aortic valve and degenerated prolapsed mitral valve

A 54-year-old man with congenital bicuspid aortic valve underwent simultaneous valve repair for aortic and mitral regurgitation. Surgical technique consisted of plication of redundant aortic valve repair and mitral annuloplasty with chordal replacement. One-year follow-up transthoracic echocardiography showed no valve regurgitation. Valve repair for both bicuspid aortic valve and mitral valve regurgitation should be the first option in this subset of patients.     

Impact of aortic root repair or replacement in severe destructive aortic valve endocarditis with paravalvular abscesses on long-term survival

 Open in a separate windowOBJECTIVESSurgical treatment of destructive infective endocarditis consists of extensive debridement followed by root repair or replacement. However, it remains unknown whether 1 is superior to the other. We aimed to analyse whether long-term results were better after root repair or replacement in patients with root endocarditis.METHODSA total of 148 consecutive patients with root endocarditis treated with surgery from 1997 to 2020 at our department were included. Patients were divided into 2 groups: aortic root repair (n = 85) or root replacement using xenografts or homografts (n = 63).RESULTSPatients receiving aortic root repair showed significantly better long-term survival compared to patients receiving aortic root replacement (log-rank: P = 0.037). There was no difference in terms of freedom from valvular reoperations among both treatment groups (log-rank: P = 0.58). Patients with aortic root repair showed higher freedom from recurrent endocarditis compared to patients with aortic root replacement (log-rank: P = 0.022). Patients with aortic root repair exhibited higher event-free survival (defined as a combination end point of freedom from death, valvular reoperation or recurrent endocarditis) compared to patients receiving aortic root replacement (log-rank: P = 0.022). Age increased the risk of mortality with 1.7% per year. Multi-variable adjusted statistical analysis revealed improved long-term event-free survival after aortic root repair (hazards ratio: 0.57, 95% confidence interval: 0.39–0.95; P = 0.031).CONCLUSIONSAortic root repair and replacement are feasible options for the surgical treatment of root endocarditis and are complementary methods, depending on the extent of infection. Patients with less advanced infection have a more favourable prognosis.Clinical trial registrationUN4232 382/3.1 (retrospective study).     

Isolated tricuspid valve stenosis caused by infective endocarditis in an adult: Report of a case

We report herein the case of a 42-year-old man in whom dyspnea on exertion was found to be caused by isolated tricuspid stenosis. Two-dimensional echocardiogram showed thickening of the tricuspid valve with a markedly enlarged right atrium. A color-flow Doppler examination-revealed severe tricuspid stenosis without regurgitation and a Doppler-derived tricuspid diastolic pressure gradient of 23 mmHg. At the time of surgery, the patient was noted to have a stenotic tricuspid valve with thickened leaflets, fused commissures, and almost normal chorda tendineae. The valve leaflets were teased apart to the scattered specimen, and tricuspid valve replacement was successfully performed. Microscopic examination of the specimen demonstrated infective endocarditis. Isolated acquired tricuspid stenosis is extremely rare and, to our knowledge, this is the first case of infective endocarditis being involved as the primary cause.     

Use of the pericardial cord as a substitute for an infected mitral prosthetic ring associated with aortic prosthetic valve endocarditis

We report the case of a 61-year-old man with prosthetic valve endocarditis after both aortic valve replacement and mitral annuloplasty. Necrotic tissue and dehiscence of the suture line in the aortic annulus were found, and the infection extended to the anterior portion of the mitral prosthetic ring. The autologous pericardial cord was used as a substitute for the infected mitral prosthetic ring, and aortic root replacement was performed with a stentless bioprosthesis. The autologous pericardial cord was useful as a substitute for an infected mitral prosthetic ring.     

61例感染性心内膜炎的诊断与治疗总结

目的 探讨感染性心内膜炎的诊断与外科治疗特点,分析外科治疗对术后短、中期疗效.方法 回顾性分析1995年1月～2008年4月期间61例感染性心内膜炎患者接受手术治疗的临床资料,总结外科治疗经验.结果 术后早期死亡4例(6.6%),术后随访6月～13年.出院患者死亡5例,其他生存患者中心功能Ⅱ级43例,Ⅲ级9例.结论 早期明确诊断、选择合适的手术时机及内、外科综合治疗是感染性心内膜炎成功治疗的关键.     

Ross operation and mitral valve repair for active infective endocarditis

A 17-year-old woman was admitted to our hospital for the treatment of infective endocarditis. Echocardiography showed vegetation on the aortic valve and the anterior leaflet of the mitral valve. Because of the evidence of multiple embolisms including coronary, splenic, and right brachial arteries, emergency Ross operation was performed using Prima PLUS stentless valve for reconstruction of the right ventricular outflow tract and so was mitral valve repair with autologous pericardial patch. Although cerebral hemorrhage occurred postoperatively, she recovered well without any neurological deficit. She was in good condition without any anticoagulation therapy 12 months after surgery. The Ross operation and mitral valve repair are useful for the treatment of aortic and mitral infective endocarditis, especially in young women with the potential of future pregnancy and labor.