Conservative mitral valve surgery in the treatment of mitral regurgitation due to infective endocarditis. Report of 21 cases

BACKGROUND: To evaluate the feasibility of mitral valve repair in patients with infective endocarditis (IE). METHODS AND RESULTS: Forty-seven patients operated for mitral endocarditis between 1995 and 2005; 21 underwent mitral valve repair. The repair was performed for acute endocarditis in seven patients at a median of 14 days after the onset of treatment and 14 patients for healed endocarditis after a median of six months. RESULTS: Mitral valve repair was feasible in 21 patients (45%). This repair involved mitral annuloplasty in 16 patients (76%), shortening or transposition of chordae in 10 patients (48%), a pericardial patch in five patients (24%), and suture of perforation in two patients (9%). Associated procedures were aortic valve replacement in seven patients and tricuspid annuloplasty in two. There were no operative deaths. The mean follow up was five years (one to 11). One patient was reoperated for severe mitral regurgitation and another had a stroke due to cerebrovascular embolism in the first postoperative years. No recurrence of infectious endocarditis occurred. CONCLUSIONS: Mitral valve repair in IE gives satisfactory results in terms of survival and symptomatic improvement with a low operative risk. With antibiotic therapy, it provides a cure of mitral lesions even when carried out in the acute phase of endocarditis. Finally, it feasible in several cases with excellent results.