MP35. Mitral Valve Repair and Replacement for Infective Endocarditis: A Propensity Matched Study
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Pietro Giorgio Malvindi is an academic cardiac surgeon working at the Azienda Ospedaliera Universitaria delle Marche within the Università Politecnica delle Marche, Ancona - Italy.
Born in Lecce (Puglia, Italy), he graduated in Medicine and Surgery and later specialist in Cardiac Surgery at the local University of Bari. In 2009 he attended the Fellowship program at St Antonius Ziekenhuis, Nieuwegein - The Netherlands, which ultimately led him to the PhD in Medical Sciences at Radboud University in Nijmegen - The Netherlands.
He served as a Cardiac Surgeon at Istituto Clinico Humanitas - Milan, Santa Maria Hospital - Bari, and the University Hospital of Southampton - Southampton, UK.
In 2020 he obtained the Italian National Qualification as Associate Professor.
Description
Methods. Prospectively collected data of patients who underwent cardiac surgery for infective endocarditis between 2001 and 2021 at two cardiac centres were reviewed. Among them, 282 patients underwent native mitral valve surgery and were included in the study. Nearest-neighbour propensity score matching was performed including fifteen variables to account for differences in patients' profile between the repair and replacement subgroups.
Results. Mitral valve replacement was performed in 186 patients, while in 96 cases patients underwent mitral valve repair.
PM analysis provided 89 well-matched pairs. Mean age was 60±15 years, 75% of the patients were male. Twenty-three patients (13%) had a recent cerebral event. Mitral valve replacement was more commonly performed in patients with involvement of both mitral leaflets, commissure(s) and mitral annulus. Patients with lesion(s) limited to P2 segment underwent in most of the cases mitral valve repair (Figure). There was no difference in terms of microbiological findings. In-hospital mortality was 7% with no difference between the repair (n=7, 7%) and the replacement (n=6, 7%) cohorts, p=0.77. Survival probabilities at 1-, 5- and 10-years were 88%, 72% and 68%, respectively after mitral repair, and 88%, 78% and 63%, respectively after mitral replacement; log-rank p=0.94. Cumulative risk of reoperation at 10-years was 3.5% after mitral valve repair and 5% after mitral valve replacement, Gray's test p=0.71.
Conclusions. Surgery for native mitral valve infective endocarditis is still associated with a non-negligible risk of mortality. Mitral valve repair was more commonly performed in patients with isolated single leaflet involvement and provided good early and mid-term outcomes. Patients with annular disruption, lesion(s) on both leaflets and commissure(s) were successfully served on early and mid-term course by mitral valve replacement.