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Long-term results of mitral valve repair in active vs cured endocarditis
Session:
Posters - F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Speaker:
André Soeiro
Congress:
CPC 2021
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
16. Infective Endocarditis
Subtheme:
16.4 Infective Endocarditis – Treatment
Session Type:
Posters
FP Number:
---
Authors:
André Soeiro; Carlos Branco; Gonçalo Coutinho; João Cardoso; António Canotilho; Pedro e. Antunes
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Introduction:</span></strong> <span style="font-size:12pt"><span style="font-family:AppleSystemUIFont">The first choice of treatment for mitral valve infectious endocarditis (IE) is valve repair. Whenever possible, it is preferable to complete a full cycle of antibiotics before surgery. However, in some cases early intervention is needed, which makes repair more technically challenging. </span></span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Objectives:</span></strong><span style="font-family:Arial,sans-serif"> Our aim was to evaluate the long-term results of mitral valve repair (MVRp) in active and cured mitral valve endocarditis.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Methods: </span></strong><span style="font-family:Arial,sans-serif">From Jan2000 to Dec2019, 88 consecutive patients with active (53.4%) and cured (46.4%) mitral valve infectious endocarditis underwent MVRp. A diagnosis of IE was made using the Duke or modified Duke criteria. Cox proportional hazards models were used to analyse risk factors for late mortality, MAVE incidence and recurrent mitral valve regurgitation/reoperation. Kaplan-Meier methods were used to plot survival curves. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Results: </span></strong><span style="font-family:Arial,sans-serif">Mean age was (Cured vs Active) 58.6%±13.5 vs 54±14.8 (p=0.133), female sex 18.2% vs 15.9% (p=0.362); mean Euroscore II 2.95</span><span style="font-family:Arial,sans-serif">±4.15% vs 8.84±10.59% (p<0.05), and mean LV ejection fraction was 61.02±8.55% vs 59.68±5.5% (p=0.377), respectively. The mean</span> <span style="font-family:Arial,sans-serif">extra-corporal circulation time was 64.5±19.7 vs. 72.3±27.5 min, p=0.138 and aortic cross-clamping was 39.3±17.9 vs. 43.9±21.3min, p=0.282, respectively. </span><span style="font-family:Arial,sans-serif">Thirty-day mortality was 0% vs. 1.1%, p=0.348. No significant differences were found concerning 10-year survival (81.3±8.1% vs. 70.5±8.7%, p=0.428, respectively). Freedom from major adverse valve-related events (MAVEs) at 10 years after surgery was 96.6±3.4% vs. 79±7.3%, p=0.027, respectively and freedom from recurrence moderate-to-severe mitral valve regurgitation and/or reoperation at 10 years was 84.4±6.7% vs. 55±9.6%, p<0.05. </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong><span style="font-family:Arial,sans-serif">Conclusions</span></strong><span style="font-family:Arial,sans-serif">: Mitral valve repair in active infectious endocarditis was associated with increased perioperative risk. Although there are no differences in 30-day and long-term mortality, there was a significant increase in MAVEs and recurrence of mitral valve regurgitation and/or reoperation.</span></span></span></span></p>
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