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Degenerative Mitral Valve Repair: Presentation with Endocarditis Does Not Affect Long-term Results
Dan Spiegelstein, Dan Loberman, Michael Stein, Maor Yasmin, Leonid Sternik, Alexander Kogan, Micha S. Feinberg, Ehud Raanani.
Chaim Sheba Medical Center, Ramat Gan, Israel.

While the advantages of mitral valve repair over replacement are well documented for degenerative myxomatous disease, the comparative long-term clinical and echocardiographic outcome of degenerative mitral valve repair in patients with endocarditis is yet to be established.
METHODS: From 2004 to date, 555 patients with degenerative mitral valve underwent repair in our department. Of them, 43 (8%) (SBE) presented for surgical repair: 27 with acute, 6 with sub-acute and 10 with healed mitral valve endocarditis. Their results were compared with the remaining 512 patients with degenerative mitral valve (non-SBE) who presented with other clinical manifestations. We prospectively followed all patients and analyzed outcomes regarding clinical improvement and echocardiography results.

RESULTS: There were no in-hospital deaths in SBE, and 2 in the non-SBE group (NS). Follow-up ranged to 9.2 years with a mean of 34±28 months and 27±26 months in SBE and non-SBE, respectively. Late all-cause mortality was 7% (3 patients) in SBE versus 2% (10 patients) in non-SBE (p=0.14). Freedom from re-operation on the mitral valve was 95% (2 patients) and 96% (21 patients) in SBE and non-SBE, respectively (p=0.7). Freedom from recurrent endocarditis was 100% in the SBE group. Late echocardiography revealed that 95% and 91% of patients in SBE and non-SBE, respectively were free from moderate to severe mitral regurgitation (p=0.6). Freedom from NYHA FC III-IV was 94% and 88% in SBE and non-SBE, respectively (p=0.02). All other late valve-related complications were similar in both groups.
CONCLUSIONS: Degenerative mitral valve repair presenting with infective endocarditis has similar mid- to long-term clinical and echocardiographic outcomes compared with non-endocarditis degenerative mitral valve. Recurrent SBE is rare.

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