Reparative surgery of the mitral valve in bacterial endocarditis

INTRODUCTION: Short and long-term results of valve repair for pure mitral insufficiency resulting from native valve endocarditis are reported in 28 consecutive patients with a mean age of 55 years (range 18-74). METHODS: Six patients had acute endocarditis, with positive blood cultures in three of them. The mean time between onset of endocarditis symptoms and operation was 23 days in patients with acute endocarditis and 4.6 years in patients with healed endocarditis. Preoperatively, 87% of the patients were in NYHA class III. Indications for operation were heart failure (24 patients) and uncontrolled sepsis (4 patients). Mitral valvuloplasty was combined with other procedures in 4 patients. There was previous underlying valve pathology in 75%. RESULTS: Mitral repair was performed according to the techniques proposed by Carpentier; in 2 cases we used an original technique consisting of a double-orifice repair. Only one patient died in the hospital (operative mortality: 3.5%). By actuarial methods 96% of the patients were alive 6 years postoperatively. During the follow-up period there was no recurrence of endocarditis and no reoperation for valvular insufficiency. Ninety-three per cent of the patients were in NYHA class I or II. CONCLUSIONS: We conclude that mitral valve repair for insufficiency resulting from bacterial endocarditis is possible in acute and healed disease, has a low operative mortality and has resulted in patients free of recurrent infection. Mitral valve repair is an attractive alternate to valve replacement in bacterial endocarditis.