Native mitral valve endocarditis suitable for successful surgical repair: clinical and echocardiographic study

Abstract Background Successful surgical mitral valve repair in native mitral valve infective endocarditis remains challenging. The present study provides further evidence on the clinical and echocardiographic characteristics of patients with native mitral infective endocarditis who underwent successful surgical mitral valve repair and on the long-term outcomes. Methods Retrospective clinical and echocardiographic evaluation of consecutive patients with native mitral valve endocarditis and indication for urgent or elective surgical treatment between 2000 and 2024 . The postoperative course and the long-term follow-up were assessed , evaluating the occurrence of death, recurrence of infective endocarditis or significant valvular dysfunction, any need for re-intervention and the occurrence of cerebrovascular events (stroke/transient ischemic accident) or major bleedings. Results Of 116 patients (60±14years , 58 % male), 82 underwent surgical valve replacement (70%) and 34 (30%) valve repair. There were no differences in terms of age and sex distribution between the two groups and the clinical characteristics were comparable except for the frequency of hypertension and atrial fibrillation that were significantly more common in the surgical replacement group. Staphylococcus and streptococcus species were the most common causative agents in both groups. Heart failure was the most common indication for surgery in both groups while uncontrolled infection was significantly more frequent in the surgical replacement group (44% vs. 9%, p 0.01). The median time from diagnosis to surgery was 7 days in both groups. In terms of echocardiographic characteristics, anterior leaflet and bi-leaflet involvement and multivalvular involvement were significantly more common in the surgical replacement group. No other differences were noted. During a median follow-up of 5 years, the observed survival rates were similar (75% in the mitral valve repair group vs 77% in the mitral valve replacement group, hazard ratio 1.03, 95% confidence interval: 0.88, 1.20, p=0.928). Interestingly, patients undergoing surgical replacement presented more frequently recurrence of endocarditis (10% vs. 3%, p = 0.21), major bleedings and neurological complications. Significant valve dysfunction was reported only in the surgical replacement group (5%, p = 0.18). Conclusion Mitral valve repair for acute infective endocarditis of the mitral valve is safe and feasible when there is no significant structural damage of the mitral valve. At intermediate follow-up, surgical repair is associated with less frequency of recurrence of endocarditis, neurological complications and valve dysfunction as compared to surgical replacement.