Long-term outcomes following mitral valvuloplasty <i>versus</i> replacement for native valve endocarditis: A case control study _Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

ZHENG Shuai , JIAO Yuqing , ZHANG Haibo , LI Yan , HAN Jie , XU Chunlei , ZENG Wen , JIA Yixin , WANG Jiangang , YANG Bin ,  MENG Xu

Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing Heart Surgery Center for Transplantation and Heart Valve Diseases, Beijing, 100029, P.R.China;

Corresponding author：

MENG Xu, Email: mxu@263.net

Keywords：

Native valve endocarditis; mitral valvuloplasty; long-term outcome

DOI：

10.7507/1007-4848.201702028

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Objective To compare long-term outcomes following mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for native valve endocarditis (NVE). Methods Between November 1993 and August 2016, consecutive 101 patients with NVE underwent mitral surgery in our department, MVP for 52 patients and MVR for 49 patients. There were 69 males and 32 females at age of 38.1±14.9 years. The mean follow-up was 99.4±75.8 months. Results There was no statistical difference in cardiopulmonary bypass time, aortic cross-clamp time, in-hospital mortality, duration of mechanical ventilation, ICU stay or hospital stay after surgery between the two groups. Survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 97.6%, 97.6% for MVP, and 93.5%, 84.3%, 84.3%, 66.2% for MVR with a statistical difference between the two groups (P=0.018). There was no stroke in the patients with MVP during follow-up periods. However, stroke-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 93.9%, 89.4%, 70.2% for MVR patients with a statistical difference between the two groups (P=0.023). There was no statistical difference in recurrence of infection, perivalvular leakage and reoperation between the two groups. Composite endpoint-free survival rate at 1, 5, 10, 20 years after surgery was 100.0%, 97.6%, 92.9%, 92.9% for MVP, and 91.3%, 79.6%, 75.8%, 51.0% for MVR with a statistical difference (P=0.006). Conclusion MVP is associated with better outcomes than MVR in the patients with NVE; generalizing MVP technique in the patients with NVE is needed.

Citation： ZHENG Shuai, JIAO Yuqing, ZHANG Haibo, LI Yan, HAN Jie, XU Chunlei, ZENG Wen, JIA Yixin, WANG Jiangang, YANG Bin, MENG Xu. Long-term outcomes following mitral valvuloplasty versus replacement for native valve endocarditis: A case control study . Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(3): 193-197. doi: 10.7507/1007-4848.201702028 Copy

1.	Lalani T, Cabell CH, Benjamin DK, et al. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation, 2010, 121(8): 1005-1013.
2.	Miro JM, Anguera I, Cabell CH, et al. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis, 2005, 41(4): 507-514.
3.	Anantha Narayanan M, Mahfood Haddad T, Kalil AC, et al. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. Heart, 2016, 102(12): 950-957.
4.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): e57-e185.
5.	Dillon J, Yakub MA, Kong PK, et al. Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for "burnt-out" rheumatic disease still inferior to repair for degenerative disease in the current era? J Thorac Cardiovasc Surg, 2015, 149(3): 771-777.
6.	Wang Z, Zhou C, Gu H, et al. Mitral valve repair versus replacement in patients with rheumatic heart disease. J Heart Valve Dis, 2013, 22(3): 333-339.
7.	Kim JB, Kim HJ, Moon DH, et al. Long-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement. Eur J Cardiothorac Surg, 2010, 37(5): 1039-1046.
8.	Iung B, Rousseau-Paziaud J, Cormier B, et al. Contemporary results of mitral valve repair for infective endocarditis. J Am Coll Cardiol, 2004, 43(3): 386-392.
9.	Ruttmann E, Legit C, Poelzl G, et al. Mitral valve repair provides improved outcome over replacement in active infective endocarditis. J Thorac Cardiovasc Surg. 2005; 130(3): 765-71.
10.	Shang E, Forrest GN, Chizmar T, et al. Mitral valve infective endocarditis: benefit of early operation and aggressive use of repair. Ann Thorac Surg, 2009, 87(6): 1728-1734.
11.	鲍家银, 陈海宇, 翁国星, 等. 232 例感染性心内膜炎的外科治疗. 中国循环杂志, 2012, 27(5): 376-378.
12.	陈国祥, 熊利华, 张华, 等. 15 例感染性心内膜炎的外科治疗. 岭南心血管病杂志, 2005, 11(4): 238-240.
13.	周一民, 岳世昌, 张东明, 等. 26 例原发性感染性心内膜炎的外科治疗. 心肺血管病杂志, 2005, 24(2): 96-97.
14.	陈金淼, 洪涛, 王春生, 等. 感染性心内膜炎并发卒中的手术时机. 中华胸心血管外科杂志, 2014, 30(9): 562-563.
15.	张文, 严晓伟, 王爱民, 等. 感染性心内膜炎误诊研究. 中国误诊学杂志, 2001, 1(1): 33-36.
16.	Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015, 36(44): 3075-3128.
17.	Angstwurm K, Borges AC, Halle E, et al. Timing the valve replacement in infective endocarditis involving the brain . J Neurol, 2004, 251(10): 1220-1226.
18.	Yoshioka D, Sakaguchi T, Yamauchi T, et al. Impact of early surgical treatment on postoperative neurologic outcome for active infective endocarditis complicated by cerebral infarction . Ann Thorac Surg, 2012, 94(2): 489-495.

1. Lalani T, Cabell CH, Benjamin DK, et al. Analysis of the impact of early surgery on in-hospital mortality of native valve endocarditis: use of propensity score and instrumental variable methods to adjust for treatment-selection bias. Circulation, 2010, 121(8): 1005-1013.
2. Miro JM, Anguera I, Cabell CH, et al. Staphylococcus aureus native valve infective endocarditis: report of 566 episodes from the International Collaboration on Endocarditis Merged Database. Clin Infect Dis, 2005, 41(4): 507-514.
3. Anantha Narayanan M, Mahfood Haddad T, Kalil AC, et al. Early versus late surgical intervention or medical management for infective endocarditis: a systematic review and meta-analysis. Heart, 2016, 102(12): 950-957.
4. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol, 2014, 63(22): e57-e185.
5. Dillon J, Yakub MA, Kong PK, et al. Comparative long-term results of mitral valve repair in adults with chronic rheumatic disease and degenerative disease: is repair for "burnt-out" rheumatic disease still inferior to repair for degenerative disease in the current era? J Thorac Cardiovasc Surg, 2015, 149(3): 771-777.
6. Wang Z, Zhou C, Gu H, et al. Mitral valve repair versus replacement in patients with rheumatic heart disease. J Heart Valve Dis, 2013, 22(3): 333-339.
7. Kim JB, Kim HJ, Moon DH, et al. Long-term outcomes after surgery for rheumatic mitral valve disease: valve repair versus mechanical valve replacement. Eur J Cardiothorac Surg, 2010, 37(5): 1039-1046.
8. Iung B, Rousseau-Paziaud J, Cormier B, et al. Contemporary results of mitral valve repair for infective endocarditis. J Am Coll Cardiol, 2004, 43(3): 386-392.
9. Ruttmann E, Legit C, Poelzl G, et al. Mitral valve repair provides improved outcome over replacement in active infective endocarditis. J Thorac Cardiovasc Surg. 2005; 130(3): 765-71.
10. Shang E, Forrest GN, Chizmar T, et al. Mitral valve infective endocarditis: benefit of early operation and aggressive use of repair. Ann Thorac Surg, 2009, 87(6): 1728-1734.
11. 鲍家银, 陈海宇, 翁国星, 等. 232 例感染性心内膜炎的外科治疗. 中国循环杂志, 2012, 27(5): 376-378.
12. 陈国祥, 熊利华, 张华, 等. 15 例感染性心内膜炎的外科治疗. 岭南心血管病杂志, 2005, 11(4): 238-240.
13. 周一民, 岳世昌, 张东明, 等. 26 例原发性感染性心内膜炎的外科治疗. 心肺血管病杂志, 2005, 24(2): 96-97.
14. 陈金淼, 洪涛, 王春生, 等. 感染性心内膜炎并发卒中的手术时机. 中华胸心血管外科杂志, 2014, 30(9): 562-563.
15. 张文, 严晓伟, 王爱民, 等. 感染性心内膜炎误诊研究. 中国误诊学杂志, 2001, 1(1): 33-36.
16. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC Guidelines for the management of infective endocarditis: The Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015, 36(44): 3075-3128.
17. Angstwurm K, Borges AC, Halle E, et al. Timing the valve replacement in infective endocarditis involving the brain . J Neurol, 2004, 251(10): 1220-1226.
18. Yoshioka D, Sakaguchi T, Yamauchi T, et al. Impact of early surgical treatment on postoperative neurologic outcome for active infective endocarditis complicated by cerebral infarction . Ann Thorac Surg, 2012, 94(2): 489-495.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Long-term outcomes following mitral valvuloplasty versus replacement for native valve endocarditis: A case control study

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