Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery
<i>Background:</i> Mitral valve repair is preferred in patients undergoing surgical treatment for infective endocarditis (IE) of the native mitral valve, however, radical resection of infected tissue and patch-plasty might potentially lead to low or non-durable repair. We aimed to compar...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-03-01
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| Series: | Journal of Cardiovascular Development and Disease |
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| Online Access: | https://www.mdpi.com/2308-3425/10/4/146 |
| _version_ | 1797604926607589376 |
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| author | Zaki Haidari Daniel Wendt Matthias Thielmann Heinz Jakob Arjang Ruhparwar Mohamed El-Gabry |
| author_facet | Zaki Haidari Daniel Wendt Matthias Thielmann Heinz Jakob Arjang Ruhparwar Mohamed El-Gabry |
| author_sort | Zaki Haidari |
| collection | DOAJ |
| description | <i>Background:</i> Mitral valve repair is preferred in patients undergoing surgical treatment for infective endocarditis (IE) of the native mitral valve, however, radical resection of infected tissue and patch-plasty might potentially lead to low or non-durable repair. We aimed to compare a limited-resection and non-patch technique with the classic radical-resection technique. <i>Methods:</i> Eligible candidates were patients with definitive IE of the native mitral valve undergoing surgery between January 2013 and December 2018. Patients were classified according to the surgical strategy into two groups: limited- versus radical-resection strategy. Propensity score matching was used. Endpoints were repair rate, all-cause mortality (30-day and 2-year), re-endocarditis and reoperation at q-year follow-up. <i>Results:</i> After propensity score matching, 90 patients were included. Follow-up was 100% complete. Mitral valve repair rate was 84% in the limited-resection versus 18% in the radical-resection strategy, <i>p</i> < 0.001. The 30-day and 2-year mortality were 20% versus 13% (<i>p</i> = 0.396) and 33% versus 27% (<i>p</i> = 0.490) in the limited-resection versus radical-resection strategy, respectively. The incidence of re-endocarditis during the 2-year follow-up was 4% in the limited-resection strategy versus 9% in the radical-resection strategy, <i>p</i> = 0.677. Three patients in the limited-resection strategy underwent reoperation of the mitral valve, while there were none in the radical-resection strategy (<i>p</i> = 0.242). <i>Conclusions:</i> Although mortality in patients with IE of the native mitral valve remains high, the limited-resection and non-patch surgical strategy is associated with a significantly higher repair rates with comparable 30-day and mid-term mortality, risk of re-endocarditis and re-operation compared to the radical-resection strategy. |
| first_indexed | 2024-03-11T04:53:46Z |
| format | Article |
| id | doaj.art-228b5b2952f64c809a8241b1414ce5a3 |
| institution | Directory Open Access Journal |
| issn | 2308-3425 |
| language | English |
| last_indexed | 2024-03-11T04:53:46Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Cardiovascular Development and Disease |
| spelling | doaj.art-228b5b2952f64c809a8241b1414ce5a32023-11-17T19:47:28ZengMDPI AGJournal of Cardiovascular Development and Disease2308-34252023-03-0110414610.3390/jcdd10040146Limited versus Radical Resection in Mitral Valve Infective Endocarditis SurgeryZaki Haidari0Daniel Wendt1Matthias Thielmann2Heinz Jakob3Arjang Ruhparwar4Mohamed El-Gabry5Department of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, GermanyDepartment of Thoracic and Cardiovascular Surgery, West German Heart and Vascular Centre Essen, University Hospital Essen, Hufelandstrasse 55, 45147 Essen, Germany<i>Background:</i> Mitral valve repair is preferred in patients undergoing surgical treatment for infective endocarditis (IE) of the native mitral valve, however, radical resection of infected tissue and patch-plasty might potentially lead to low or non-durable repair. We aimed to compare a limited-resection and non-patch technique with the classic radical-resection technique. <i>Methods:</i> Eligible candidates were patients with definitive IE of the native mitral valve undergoing surgery between January 2013 and December 2018. Patients were classified according to the surgical strategy into two groups: limited- versus radical-resection strategy. Propensity score matching was used. Endpoints were repair rate, all-cause mortality (30-day and 2-year), re-endocarditis and reoperation at q-year follow-up. <i>Results:</i> After propensity score matching, 90 patients were included. Follow-up was 100% complete. Mitral valve repair rate was 84% in the limited-resection versus 18% in the radical-resection strategy, <i>p</i> < 0.001. The 30-day and 2-year mortality were 20% versus 13% (<i>p</i> = 0.396) and 33% versus 27% (<i>p</i> = 0.490) in the limited-resection versus radical-resection strategy, respectively. The incidence of re-endocarditis during the 2-year follow-up was 4% in the limited-resection strategy versus 9% in the radical-resection strategy, <i>p</i> = 0.677. Three patients in the limited-resection strategy underwent reoperation of the mitral valve, while there were none in the radical-resection strategy (<i>p</i> = 0.242). <i>Conclusions:</i> Although mortality in patients with IE of the native mitral valve remains high, the limited-resection and non-patch surgical strategy is associated with a significantly higher repair rates with comparable 30-day and mid-term mortality, risk of re-endocarditis and re-operation compared to the radical-resection strategy.https://www.mdpi.com/2308-3425/10/4/146infective endocarditismitral valvecardiac surgerylimited-resectionradical-resection |
| spellingShingle | Zaki Haidari Daniel Wendt Matthias Thielmann Heinz Jakob Arjang Ruhparwar Mohamed El-Gabry Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery Journal of Cardiovascular Development and Disease infective endocarditis mitral valve cardiac surgery limited-resection radical-resection |
| title | Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery |
| title_full | Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery |
| title_fullStr | Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery |
| title_full_unstemmed | Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery |
| title_short | Limited versus Radical Resection in Mitral Valve Infective Endocarditis Surgery |
| title_sort | limited versus radical resection in mitral valve infective endocarditis surgery |
| topic | infective endocarditis mitral valve cardiac surgery limited-resection radical-resection |
| url | https://www.mdpi.com/2308-3425/10/4/146 |
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