Understanding Surgical Management and Outcomes in Mitral Valve Endocarditis

<b>Objectives</b>: 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. <b>Methods</b>: 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. <b>Results</b>: 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 (<i>p</i> < 0.001), subvalvular apparatus involvement (<i>p</i> = 0.008), and abscess formation (<i>p</i> = 0.047) were more likely to require valve replacement. The 30-day mortality rate was 12.1% (<i>n</i> = 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; <i>p</i> < 0.001), even after propensity score matching (92.6% ± 5.0% vs. 62.4% ± 9.0% at 5 years; <i>p</i> = 0.034). <b>Conclusions</b>: 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.