Dzilic Elda, Niedermayer Samuel, Burri Melchior, Amabile Andrea, Krane Markus, Vitanova Keti
Department of Cardiovascular Surgery, Institute Insure, German Heart Center Munich, School of Medicine & Health, Technical University of Munich, 80639 Munich, Germany.
Department of Nephrology, School of Medicine, Klinikum Rechts der Isar, Technical University of Munich, 81675 Munich, Germany.
J Clin Med. 2025 Apr 15;14(8):2712. doi: 10.3390/jcm14082712.
: Surgical patients with mitral valve endocarditis can be treated with valve reconstruction or valve replacement. Although valve repair should be preferred, the decision between the two options is nuanced. : In this single-center, retrospective cohort study, we included all patients who underwent surgery for native mitral valve endocarditis between February 2001 and June 2019. We analyzed the surgical outcomes, survival, and factors leading to valve repair versus replacement. Propensity score matching was performed to minimize treatment assignment bias and improve comparability between the two groups. : This study included 281 consecutive patients with mitral valve endocarditis, of whom 46 (16.4%) underwent mitral valve repair and 235 (83.6%) underwent mitral valve replacement. The mean follow-up was 5.2 ± 5.1 years. Cases with bileaflet endocarditis ( < 0.001), subvalvular apparatus involvement ( = 0.008), and abscess formation ( = 0.047) were more likely to require valve replacement. The 30-day mortality rate was 12.1% ( = 34). Patients who underwent repair had significantly better survival than those who underwent replacement (92.7% ± 4.1% vs. 59.4% ± 3.4% at 5 years; < 0.001), even after propensity score matching (92.6% ± 5.0% vs. 62.4% ± 9.0% at 5 years; = 0.034). : In patients with mitral valve endocarditis, mitral valve repair had better long-term survival, even after propensity score matching, highlighting the potential benefit of valve preservation techniques.
二尖瓣心内膜炎的外科手术患者可采用瓣膜重建或瓣膜置换治疗。虽然应首选瓣膜修复，但在这两种选择之间做出决定需要细致考虑。在这项单中心回顾性队列研究中，我们纳入了2001年2月至2019年6月期间因原发性二尖瓣心内膜炎接受手术的所有患者。我们分析了手术结果、生存率以及导致瓣膜修复与置换的因素。进行倾向评分匹配以尽量减少治疗分配偏倚并提高两组之间的可比性。本研究纳入了281例连续的二尖瓣心内膜炎患者，其中46例（16.4%）接受了二尖瓣修复，235例（83.6%）接受了二尖瓣置换。平均随访时间为5.2±5.1年。双叶心内膜炎（<0.001）、瓣下结构受累（=0.008）和脓肿形成（=0.047）的病例更有可能需要瓣膜置换。30天死亡率为12.1%（=34）。接受修复的患者的生存率明显高于接受置换的患者（5年时为92.7%±4.1%对59.4%±3.4%；<0.001），即使在倾向评分匹配后也是如此（5年时为92.6%±5.0%对62.4%±9.0%；=0.034）。在二尖瓣心内膜炎患者中，即使在倾向评分匹配后，二尖瓣修复的长期生存率也更高，这突出了瓣膜保留技术的潜在益处。
