El Gabry Mohamed, Haidari Zaki, Mourad Fanar, Nowak Janine, Tsagakis Konstantinos, Thielmann Matthias, Wendt Daniel, Jakob Heinz, Shehada Sharaf-Eldin
Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Essen, Germany.
Interact Cardiovasc Thorac Surg. 2019 Dec 1;29(6):823-829. doi: 10.1093/icvts/ivz187.
Mitral valve repair (MVR) is considered the treatment of choice for mitral valve (MV) regurgitation. However, MVR in acute native MV infective endocarditis is technically challenging and not commonly performed. Our goal was to report our outcomes of MVR in acute native MV infective endocarditis.
Between January 2016 and December 2017, 35 patients presenting with acute native MV infective endocarditis underwent MVR. Primary end points were successful MVR and freedom from recurrent endocarditis. Secondary end point was the postoperative incidence of major adverse events.
The mean age was 58 ± 13 years (74% men) and the median logistic EuroSCORE was 17.1%. Twenty patients underwent isolated MVR; the other 15 patients underwent concomitant procedures. MVR was performed with removal of the vegetation (vegectomy), limited resection of the infected tissue, direct closure of the defect, besides annuloplasty in all patients. Mean intensive care and hospital stays were 5 and 17 days, respectively. All-cause mortality was 11% (4/35) at 30 days and a total of 23% (8/35) within a follow-up period of 10 ± 7.7 months. Endocarditis recurred in 2 patients 15 and 8 months after surgery, respectively. Both underwent successful MV re-repair. Follow-up echocardiography indicated none-to-trace, mild or moderate regurgitation in 15, 10 and 2 patients, respectively.
Although MVR in acute native MV infective endocarditis is a complex procedure, it offers a treatment option for such patients with acceptable short-term results. Limited resection in addition to annuloplasty is our preferred method of repair. Nevertheless, long-term results in a larger cohort are still mandatory.
二尖瓣修复术（MVR）被认为是二尖瓣（MV）反流的首选治疗方法。然而，急性原发性MV感染性心内膜炎的MVR在技术上具有挑战性，且并不常用。我们的目标是报告急性原发性MV感染性心内膜炎患者MVR的治疗结果。
2016年1月至2017年12月期间，35例急性原发性MV感染性心内膜炎患者接受了MVR。主要终点是成功的MVR和无复发性心内膜炎。次要终点是术后主要不良事件的发生率。
平均年龄为58±13岁（74%为男性），中位逻辑欧洲心脏手术风险评估系统（EuroSCORE）为17.1%。20例患者接受了单纯MVR；其他15例患者接受了同期手术。所有患者均在进行瓣环成形术的基础上，进行了赘生物清除（赘生物切除术）、感染组织的有限切除和缺损的直接闭合。平均重症监护和住院时间分别为5天和17天。30天时全因死亡率为11%（4/35），在10±7.7个月的随访期内总计为23%（8/35）。2例患者分别在术后15个月和8个月心内膜炎复发。两人均成功进行了MV再次修复。随访超声心动图显示，分别有15例、10例和2例患者无反流、轻度反流或中度反流。
尽管急性原发性MV感染性心内膜炎的MVR是一项复杂的手术，但它为此类患者提供了一种治疗选择，短期结果可以接受。除瓣环成形术外进行有限切除是我们首选的修复方法。然而，仍需要更大队列的长期结果。
