Objective: To evaluate the long-term clinical and echocardiographic outcomes after mitral valve surgery for acute and healed infective endocarditis. Methods: Of 37 consecutive patients presenting with native mitral valve endocarditis, mitral valve repair (MVRep) was feasible in 34 (92%) patients. In 17 (50%) patients, surgery was indicated during antibiotic therapy (acute endocarditis), whereas 17 (50%) underwent surgery after antibiotic therapy was completed (healed endocarditis). Patients were evaluated for early and long-term clinical and echocardiographic outcome. Results: In-hospital death occurred in two (6%) patients and two (6%) died during follow-up, with a 2-year survival of 100% in healed endocarditis as compared to 76% (p = 0.03) in patients undergoing surgery in acute endocarditis. No patient with acute endocarditis needed repeat mitral valve surgery. Three (9%) patients underwent re-operation because of early mitral regurgitation (n = 1) or late recurrent endocarditis (n = 2). The average grade of mitral regurgitation was 3.8 ± 0.4 (all grades 3 to 4+) before surgery and 0.6 ± 0.8 during follow-up (p < 0.001). Significant reductions in left atrial (from 52 ± 8 mm to 46 ± 8 mm, p = 0.004), left ventricular end-diastolic (from 61 ± 8 mm to 54 ± 8 mm, p = 0.001), and end-systolic dimensions (from 41 ± 8 mm to 36 ± 9 mm, p = 0.02) were observed during follow-up, compared to preoperative dimensions. Of note, significant reverse remodeling was only observed in patients undergoing surgery in healed endocarditis. Conclusion: MVRep for mitral valve endocarditis is feasible with good clinical results, maintained valve competency with significant reductions in left atrial and left ventricular dimensions after surgery.

Echocardiography, Infective endocarditis, Mitral valve disease, Mitral valve repair, Mitral valve replacement, Prognosis
dx.doi.org/10.1016/j.ejcts.2005.12.006, hdl.handle.net/1765/61908
European Journal of Cardio-Thoracic Surgery
Department of Cardio-Thoracic Surgery

Feringa, H.H.H, Bax, J.J, Klein, P, Klautz, R.J.M, Braun, J, van der Wall, E.E, … Dion, R. (2006). Outcome after mitral valve repair for acute and healed infective endocarditis. European Journal of Cardio-Thoracic Surgery, 29(3), 367–373. doi:10.1016/j.ejcts.2005.12.006