Surgical treatment of mitral valve endocarditis in North America

Background. Several single-institution series have suggested the feasibility and effectiveness of mitral valve repair for infective endocarditis (IE). Methods. We examined 6627 patients with IE undergoing mitral valve surgery at 661 Society of Thoracic Surgeons-participating centers in 1994 to 2003. Results. The diagnosis of IE was assigned to 5.8% (6,627 of 114,934) of patients having mitral valve surgery. The overall frequency of mitral valve repair for IE was 29.7% (1,965 of 6,627). Mitral valve repair was less frequently used for patients with active IE (423 of 2,654; 15.9%) than those with treated IE (1,459 of 3,570; 40.9%). Operative mortality was 3.7% (72 of 1,965) for mitral valve repair and 10.8% (502 of 4,662) for mitral valve replacement. Mortality rates were lower for patients with treated IE compared with active IE. After adjusting for multiple preoperative risk factors, mitral valve repair (odds ratio, 0.67; 95% confidence interval, 0.51 to 0.88) was associated with a significantly lower risk of death. Active (versus treated) IE (odds ratio, 2.12; 95% confidence interval, 1.68 to 2.68) and recent cerebrovascular accident (odds ratio, 1.71; 95% confidence interval, 1.28 to 2.31) were independent predictors of mortality. Conclusions. Mitral valve repair is less commonly applied for IE compared with other indications for mitral valve surgery. Patients with active IE were less likely to receive repair than those with treated IE. Mitral valve repair was associated with a lower risk of mortality. These results provide support for performing mitral valve repair when technically feasible in the setting of IE.