Mitral valve repair for infective endocarditis: surgical technique and long-term results

Objective. To describe surgical technique and long-term results of mitral valve repair for infective endocarditis. Material and methods. Between 2008 and 2024, 76 surgeries were performed for infective endocarditis. Mean age of patients was 41±16 years; 47 (61%) patients had active endocarditis. Positive hemoculture was obtained in 28 (37%) cases. All patients had severe mitral regurgitation. Lesion of posterior mitral leaflet was detected in 45 cases, anterior mitral leaflet — in 14 cases, bicuspid lesion in 11 and commissural lesions in 6 cases. Multicomponent reconstructions were performed in 23 patients (simultaneous resections, patches, neochordae), resections — in 20 cases, implantation of pericardial patches — in 14 patients. Suturing of marginal ruptures and small abscesses of valves was performed in 16 patients. In 3 patients, resection of vegetation on mitral chords was followed by implantation of neochordae. All patients underwent annuloplasty. Intraoperative TEE did not reveal severe regurgitation. Cardiopulmonary bypass time was 135±56 min, aortic cross-clamping time — 77±22 min. Results. There was 1 postoperative death from acute heart failure. Other patients were discharged with satisfactory MV function. Long-term results were evaluated in 60 (80%) patients. Mid-term postoperative mortality was 3% (2 patients died after 1 and 36 months from non-cardiac causes). All patients had no recurrence of endocarditis and stroke. According to TTE data, severe insufficiency was noted in 2 patients (MV replacement was performed after 1 and 3 years). In other cases, regurgitation was trivial. Thirty-six patients achieved long-term follow-up (74±39 months). There was no long-term mortality. Seven patients had moderate regurgitation, 2 patients — severe mitral insufficiency. One patient underwent MV replacement after 132 months. Other patients had no severe mitral regurgitation or stenosis. Conclusion. MV repair is feasible and provides satisfactory early and long-term results in patients with infective endocarditis.