Strategy for Active Infective Native Valve Endocarditis and Tips on Mitral Valve Repair

(Department of Cardiovascular Surgery, Komaki City Hospital, Komaki, Japan)

Masaru Sawazaki Shiro Tomari Kohji Yamana
Our strategy for active infective native mitral valve endocarditis was to perform valve plasty after stabilizing the active endocarditis with antibiotics as much as possible. From 1997 through 2007, a consecutive series of 16 patients underwent mitral valve plasty for active infective native mitral valve endocarditis at our department. The purpose of this study was to retrospectively assess the clinical results. The mean age was 54.6}13.4 years, and 69% were men. Surgical indications were uncontrolled infection. The mean time between onset and diagnosis was 51.6}68.0 days, and that between diagnosis and operation was 35.8}15.2 days. Two patients were operated in the early phase because of uncontrolled sepsis. Operative and pathological findings revealed active infection in 14 patients (87.5%). However, there were some findings healing suggesting in the vegetations. According to the underlying lesion, mitral valve lesions were classified into 4 groups: anterior leaflet prolapse (3 patients), posterior leaflet prolapse (10 patients), commissural prolapse (2 patients) and non-prolapse (1 patient). We tried to remove or slice only vegetation, and we preserved adjacent leaflet tissue as much as possible. All mitral valve were successfully repaired. There was 1 (6.3%) operative death because of cerebral hemorrhage. The mean follow-up period of the surviving 15 patients was 4.2}2.9 years. There were no late deaths, no re-operations and no recurrence of moderate to severe mitral regurgitation. We conclude that a sufficient period of pre-operative antibiotic administration improves the prognosis, and our plastic technique of limited removal of the leaflet tissue was safe and effective.
@Jpn. J. Cardiovasc. Surg.37: 155-158 (2008)