Outcomes of surgery in the treatment of isolated nonnative mitral valve infective endocarditis

Kevin L. Greason, Mathew Thomas, James M. Steckelberg, Richard C. Daly, Hartzell V Schaff, Zhuo Li, Joseph A. Dearani

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Objective: We reviewed our experience with the operative management of patients with isolated nonnative mitral valve infective endocarditis to better understand the outcome. Methods: We reviewed the records of 39 patients operated on for isolated nonnative mitral valve infective endocarditis from January 1974 to June 2009. Median age of the group was 68 years. There were 23 (59%) women. Prostheses were mechanical in 18 (46%) patients, biological in 18 (46%), and annuloplasty rings in 3 (8%). Staphylococcus was present in 22 (56%) patients. Operative indications included valve dysfunction in 26 (67%) patients and heart failure in 22 (56%). Results: Perivalvular abscess was present in 12 (31%) patients. Replacement valves were mechanical in 23 (59%) patients and biological in 16 (41%). Twenty (51%) patients received additional operative procedures. Treatment-related mortality occurred in 8 (21%) patients, with age being the only factor predictive of mortality (hazard ratio, 5.37). Follow-up of the survivors was 5.7 years. Six (18%) patients underwent repeat mitral valve replacement including 3 who had an annulus abscess at the initial operation and 2 who had the prosthesis sutured to the left atrial wall. There was 1 (4%) case of recurrent endocarditis in the group of 28 patients who survived more than 1 year after the incident operation. Survival at 5 years was 48% (95% confidence interval, 35%-67%). Conclusions: Surgery for isolated nonnative mitral valve infective endocarditis carries increased operative risk. Aggressive debridement and reconstruction of the annulus are paramount to achieving a good outcome. Surviving patients obtain high rates of cure and freedom from recurrent infective endocarditis.

Original languageEnglish (US)
Pages (from-to)349-354
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume147
Issue number1
DOIs
StatePublished - Jan 2014

Fingerprint

Endocarditis
Mitral Valve
Therapeutics
Abscess
Prostheses and Implants
Mortality
Operative Surgical Procedures
Debridement
Staphylococcus
Survivors
Heart Failure
Age Groups
Confidence Intervals

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Outcomes of surgery in the treatment of isolated nonnative mitral valve infective endocarditis. / Greason, Kevin L.; Thomas, Mathew; Steckelberg, James M.; Daly, Richard C.; Schaff, Hartzell V; Li, Zhuo; Dearani, Joseph A.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 147, No. 1, 01.2014, p. 349-354.

Research output: Contribution to journalArticle

Greason, Kevin L. ; Thomas, Mathew ; Steckelberg, James M. ; Daly, Richard C. ; Schaff, Hartzell V ; Li, Zhuo ; Dearani, Joseph A. / Outcomes of surgery in the treatment of isolated nonnative mitral valve infective endocarditis. In: Journal of Thoracic and Cardiovascular Surgery. 2014 ; Vol. 147, No. 1. pp. 349-354.
@article{d665ecf58b8b4860976822e28b20c8d9,
title = "Outcomes of surgery in the treatment of isolated nonnative mitral valve infective endocarditis",
abstract = "Objective: We reviewed our experience with the operative management of patients with isolated nonnative mitral valve infective endocarditis to better understand the outcome. Methods: We reviewed the records of 39 patients operated on for isolated nonnative mitral valve infective endocarditis from January 1974 to June 2009. Median age of the group was 68 years. There were 23 (59{\%}) women. Prostheses were mechanical in 18 (46{\%}) patients, biological in 18 (46{\%}), and annuloplasty rings in 3 (8{\%}). Staphylococcus was present in 22 (56{\%}) patients. Operative indications included valve dysfunction in 26 (67{\%}) patients and heart failure in 22 (56{\%}). Results: Perivalvular abscess was present in 12 (31{\%}) patients. Replacement valves were mechanical in 23 (59{\%}) patients and biological in 16 (41{\%}). Twenty (51{\%}) patients received additional operative procedures. Treatment-related mortality occurred in 8 (21{\%}) patients, with age being the only factor predictive of mortality (hazard ratio, 5.37). Follow-up of the survivors was 5.7 years. Six (18{\%}) patients underwent repeat mitral valve replacement including 3 who had an annulus abscess at the initial operation and 2 who had the prosthesis sutured to the left atrial wall. There was 1 (4{\%}) case of recurrent endocarditis in the group of 28 patients who survived more than 1 year after the incident operation. Survival at 5 years was 48{\%} (95{\%} confidence interval, 35{\%}-67{\%}). Conclusions: Surgery for isolated nonnative mitral valve infective endocarditis carries increased operative risk. Aggressive debridement and reconstruction of the annulus are paramount to achieving a good outcome. Surviving patients obtain high rates of cure and freedom from recurrent infective endocarditis.",
author = "Greason, {Kevin L.} and Mathew Thomas and Steckelberg, {James M.} and Daly, {Richard C.} and Schaff, {Hartzell V} and Zhuo Li and Dearani, {Joseph A.}",
year = "2014",
month = "1",
doi = "10.1016/j.jtcvs.2012.12.007",
language = "English (US)",
volume = "147",
pages = "349--354",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "1",

}

TY - JOUR

T1 - Outcomes of surgery in the treatment of isolated nonnative mitral valve infective endocarditis

AU - Greason, Kevin L.

AU - Thomas, Mathew

AU - Steckelberg, James M.

AU - Daly, Richard C.

AU - Schaff, Hartzell V

AU - Li, Zhuo

AU - Dearani, Joseph A.

PY - 2014/1

Y1 - 2014/1

N2 - Objective: We reviewed our experience with the operative management of patients with isolated nonnative mitral valve infective endocarditis to better understand the outcome. Methods: We reviewed the records of 39 patients operated on for isolated nonnative mitral valve infective endocarditis from January 1974 to June 2009. Median age of the group was 68 years. There were 23 (59%) women. Prostheses were mechanical in 18 (46%) patients, biological in 18 (46%), and annuloplasty rings in 3 (8%). Staphylococcus was present in 22 (56%) patients. Operative indications included valve dysfunction in 26 (67%) patients and heart failure in 22 (56%). Results: Perivalvular abscess was present in 12 (31%) patients. Replacement valves were mechanical in 23 (59%) patients and biological in 16 (41%). Twenty (51%) patients received additional operative procedures. Treatment-related mortality occurred in 8 (21%) patients, with age being the only factor predictive of mortality (hazard ratio, 5.37). Follow-up of the survivors was 5.7 years. Six (18%) patients underwent repeat mitral valve replacement including 3 who had an annulus abscess at the initial operation and 2 who had the prosthesis sutured to the left atrial wall. There was 1 (4%) case of recurrent endocarditis in the group of 28 patients who survived more than 1 year after the incident operation. Survival at 5 years was 48% (95% confidence interval, 35%-67%). Conclusions: Surgery for isolated nonnative mitral valve infective endocarditis carries increased operative risk. Aggressive debridement and reconstruction of the annulus are paramount to achieving a good outcome. Surviving patients obtain high rates of cure and freedom from recurrent infective endocarditis.

AB - Objective: We reviewed our experience with the operative management of patients with isolated nonnative mitral valve infective endocarditis to better understand the outcome. Methods: We reviewed the records of 39 patients operated on for isolated nonnative mitral valve infective endocarditis from January 1974 to June 2009. Median age of the group was 68 years. There were 23 (59%) women. Prostheses were mechanical in 18 (46%) patients, biological in 18 (46%), and annuloplasty rings in 3 (8%). Staphylococcus was present in 22 (56%) patients. Operative indications included valve dysfunction in 26 (67%) patients and heart failure in 22 (56%). Results: Perivalvular abscess was present in 12 (31%) patients. Replacement valves were mechanical in 23 (59%) patients and biological in 16 (41%). Twenty (51%) patients received additional operative procedures. Treatment-related mortality occurred in 8 (21%) patients, with age being the only factor predictive of mortality (hazard ratio, 5.37). Follow-up of the survivors was 5.7 years. Six (18%) patients underwent repeat mitral valve replacement including 3 who had an annulus abscess at the initial operation and 2 who had the prosthesis sutured to the left atrial wall. There was 1 (4%) case of recurrent endocarditis in the group of 28 patients who survived more than 1 year after the incident operation. Survival at 5 years was 48% (95% confidence interval, 35%-67%). Conclusions: Surgery for isolated nonnative mitral valve infective endocarditis carries increased operative risk. Aggressive debridement and reconstruction of the annulus are paramount to achieving a good outcome. Surviving patients obtain high rates of cure and freedom from recurrent infective endocarditis.

UR - http://www.scopus.com/inward/record.url?scp=84890553548&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84890553548&partnerID=8YFLogxK

U2 - 10.1016/j.jtcvs.2012.12.007

DO - 10.1016/j.jtcvs.2012.12.007

M3 - Article

C2 - 23317945

AN - SCOPUS:84890553548

VL - 147

SP - 349

EP - 354

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 1

ER -