Author + information
- Nana Toyoda,
- Shinobu Itagaki,
- Natalia Egorova,
- David Adams and
- Joanna Chikwe
Background: Guidelines recommend repair over replacement for native mitral valve infective endocarditis (IE). Data is limited to small series: we therefore evaluated state-wide outcomes.
Methods: From mandatory state databases we identified 3,976 adults who had mitral surgery for IE between 1998-2010 in California and New York. Previous replacement (n=296, 7.4%), other valve surgery (n=1548, 38.9%), and injection drug users (n=603, 15.2%) were excluded. The primary outcome was 10-year mortality. Multivariable regression was used to adjust for baseline variables. Median follow up time was 5.6 years (range 0-17.4), last follow up was May 2015.
Results: Overall repair rate was 18.6% (n=367/1,970). Repaired patients were younger (mean age 54.9 (±15.3) vs 57.4 (±14.6), p=0.005) and had less heart failure (46.3% vs 57.1%, p<0.001). Replacement was performed on average 2 days later than repair (p<0.001). The 10-year survival was better after repair (71.0% [95% confidence interval (CI) 64.8 – 76.3] vs. 57.4% [95% CI 54.5-60.1]) (p< 0.001) (adjusted hazard ratio [HR] 0.72; 95% CI 0.58-0.90; p=0.004) and recurrent IE rates were lower (4.0% [95% CI 2.3-6.4] vs. 7.6% [95% CI 6.3-9.2], HR= 0.52; 95% CI 0.28-0.99; p=0.047). Mitral reoperation rates were similar after repair (8.5% [95% CI 5.9-11.7]) and replacement (7.5% [95% CI 6.0-9.0] HR 1.3, 95% CI 0.8-2.1, p=0.30).
Conclusions: Mitral repair is preferable to replacement for native mitral valve IE. Low repair rates highlight a need for focused surgeon experience.
Moderated Poster Contributions
Valvular Heart Disease Moderated Poster Theater, Poster Hall, Hall C
Sunday, March 19, 2017, 1:30 p.m.-1:40 p.m.
Session Title: Infectious Endocarditis: Comprehensive Perspectives
Abstract Category: 36. Valvular Heart Disease: Clinical
Presentation Number: 1313M-11
- 2017 American College of Cardiology Foundation