Longitudinal Outcomes of Mitral Valve Surgery for Infective Endocarditis Within a Repair-First Strategy.

Abstract

Mitral valve (MV) infective endocarditis (IE) often necessitates surgical intervention for severe mitral regurgitation, yet the longitudinal impact of MV surgery within a repair-first strategy remains unclear. An institutional multidisciplinary endocarditis database incorporating Society of Thoracic Surgeons data identified patients undergoing MV surgery for acute IE between July 2016 and June 2024. Patients were managed with a repair-first operative strategy, with MV replacement reserved for cases in which repair was not feasible. Primary outcomes were survival and the composite of reinfection, reoperation, or death. Secondary measures included perioperative outcomes and the individual components of the composite. 198 total patients underwent first-time MV intervention for infective endocarditis [Repair 102 (51.5%)] or replacement [96 (48.5%)]. The repair group was younger (45 vs 51 years, p=0.03) and had fewer prior non-mitral cardiac surgeries (18.6% vs 34.4%, p=0.01). The repair group had less prolonged ventilation (14.7% vs 32.3%, p=0.003) and shorter intensive care unit stay (73 vs 121 hours, p<0.0001). Mitral valve repair was associated with superior risk-adjusted survival (HR 0.49, p=0.01) and freedom from the composite outcome of reoperation, reinfection, or death (HR 0.27, p<0.0001). Complex MV repair (defined as leaflet modification and/or patch reconstruction) in acute IE is safe and durable. Within a repair-first strategy, successful repair was associated with favorable perioperative recovery and improved mid-term outcomes. These findings support a repair-first approach when anatomically and technically feasible.