Mihaljevic Tomislav, Paul Subroto, Leacche Marzia, Rawn James D, Aranki Sary, O'Gara Patrick T, Cohn Lawrence H, Byrne John G
Division of Cardiac Surgery, Department of Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02115, USA.
J Heart Valve Dis. 2004 Mar;13(2):210-6.
Mitral valve repair has been shown superior to valve replacement for the treatment of non-infectious valve disease. The criteria and results of valve repair for native valve endocarditis are still being defined. The study aim was to examine the short- and long-term results of mitral valve repair and replacement for acute infective endocarditis and to define criteria for the use of each technique.
A total of 53 consecutive patients who presented with acute native mitral valve infective endocarditis (diagnosed less than six weeks before surgery) between January 1992 and June 2002 was retrospectively analyzed.
Twenty-one patients (40%) underwent mitral valve repair, and 32 (60%) underwent valve replacement. Operative mortality was 0% for the repair group and 13% (4/32) for the replacement group (p = 0.14). Median follow up was 4 years (range: 6-108 months). At five years follow up, a median ejection fraction (EF) of 60% and mitral regurgitation (MR) grade of 1/4 was observed, with an overall late survival of 85% (19/21), in the repair group, while the replacement group had a median EF of 55% and an overall late survival of 73% (p = 0.73). Recurrent endocarditis occurred in 2/21 (10%) in the repair group and 1/32 (3%) in the replacement group (p = 0.34).
Mitral valve repair is a safe and effective technique to treat acute native mitral valve infective endocarditis with favorable short- and long-term morbidity and mortality. Patients with advanced endocarditis and annular destruction require valve replacement. Mitral valve repair should be performed when technically feasible.
二尖瓣修复术已被证明在治疗非感染性瓣膜疾病方面优于瓣膜置换术。天然瓣膜心内膜炎瓣膜修复的标准和结果仍有待明确。本研究的目的是检查二尖瓣修复和置换治疗急性感染性心内膜炎的短期和长期结果，并确定每种技术的使用标准。
回顾性分析了1992年1月至2002年6月期间连续出现急性天然二尖瓣感染性心内膜炎（术前诊断时间少于六周）的53例患者。
21例患者（40%）接受了二尖瓣修复术，32例（60%）接受了瓣膜置换术。修复组手术死亡率为0%，置换组为13%（4/32）（p = 0.14）。中位随访时间为4年（范围：6 - 108个月）。在五年随访时，修复组的中位射血分数（EF）为60%，二尖瓣反流（MR）分级为1/4，总体晚期生存率为85%（19/21），而置换组的中位EF为55%，总体晚期生存率为73%（p = 0.73）。修复组2/21（10%）发生复发性心内膜炎，置换组1/32（3%）发生（p = 0.34）。
二尖瓣修复术是治疗急性天然二尖瓣感染性心内膜炎的一种安全有效的技术，具有良好的短期和长期发病率及死亡率。患有晚期心内膜炎和瓣环破坏的患者需要进行瓣膜置换。在技术可行时应进行二尖瓣修复术。
