A Nationwide Study on Mitral Valve Repair Versus Replacement for Active Endocarditis.

BACKGROUND: Real-world evidence supporting the reproducibility and superiority of valve repair over replacement in active mitral valve infective endocarditis is lacking.

METHODS: Data from a prospective nationwide database including all cardiac surgical procedures in the Netherlands was used. Adult patients undergoing primary mitral valve intervention who were diagnosed with active infective endocarditis and underwent surgery between 2013 and 2020 were included. Survival analysis was performed for the whole follow-up period as well as after applying the landmark of 90 days.

RESULTS: Of 715 patients who met the inclusion criteria, (n=294, 41.1%) underwent valve repair. Mitral valve repair rates decreased slightly over the course of the study. Early mortality rate was 13.0% and a trend of steadily declining early mortality rates over the course of the study, despite a steady increase in patient complexity, was observed. On risk adjusted analysis, mitral valve replacement demonstrated inferior results when compared to valve repair (adjusted hazards ratio 2.216, 95% CI 1.425-3.448, P<0.001), even after a landmark analysis was performed (adjusted hazards ratio 2.489, 95% CI 1.124-5.516, P=0.025). These results were confirmed by a propensity adjusted score analysis (adjusted hazards ratio 2.251, 95% CI 1.029-4.21, P=0.042).

CONCLUSIONS: Contemporary trends in mitral valve surgery for active infective endocarditis suggest growing patient complexity but slightly declining early mortality rates. A trend of decreasing mitral valve repair rates was seen. Our results suggest improved late outcomes of valve repair compared to replacement.