GAN Lixi 1 , CHEN Fanyu 2 , CHEN Oudi 3 , WANG Weiteng 1 , QING Hongkun 2 , YE Lanxin 1 , JIAN Xuhua 2
  • 1. Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510010, P. R. China;
  • 2. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510010, P. R. China;
  • 3. Department of Echocardiography, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510010, P. R. China;
JIAN Xuhua, Email: jianxuhua@gdph.org.cn
Infective endocarditis; mitral regurgitation; mitral valvuloplasty; mitral valve replacement; EuroSCORE-Ⅱ
10.7507/1007-4848.202310040
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Objective To compare the clinical outcomes of mitral valvuloplasty (MVP) and mitral valve replacement (MVR) for infective endocarditis, and to investigate the effect of MVP under different surgical risks. Methods A retrospective study was done on the patients with mitral infective endocarditis, who underwent surgical treatment in our department from January 2018 to March 2022. Among them, the patients receiving mitral valve repair were divided into a MVP group, and the patients receiving mitral valve replacement were divided into a MVR group. Propensity score matching method was applied with a ratio of 1∶1 to eliminate the biases. The early and midterm outcomes were compared between the two groups after matching. According to the European System for Cardiac Operative Risk Evaluation Ⅱ(EuroSCORE-Ⅱ), the effect of MVP was compared between high and low risk patients. Results A total of 195 patients were collected. There were 141 patients in the MVP group (102 males, 85.1%) and 54 patients in the MVR group (41 males, 75.9%). Patients in the MVP group were younger (43.0±14.6 years vs. 57.0±13.0, P<0.001) and had better preoperative conditions. The mean follow-up time was 30.4±16.1 months. The patients in the MVP group had a shorter ICU stay (5.0±5.4 d vs. 7.0±7.0 d, P=0.037), and lower incidences of low cardiac output syndrome (0.7% vs. 9.3%, P=0.007), in-hospital mortality (0.0% vs. 3.7%, P=0.023), and follow-up mortality (4.3% vs. 15.4%, P=0.007). However, after 1∶1 propensity score matching, there were no statistical differences in the postoperative and follow-up adverse events between the two groups (P>0.05). Also, there was no statistical difference in the mortality of high-risk patients between MVP and MVR group (P>0.05). There was no statistical difference in the reoperation and recurrent severe mitral regurgitation between high and low-risk patients in the MVP group (P>0.05). Conclusion  MVP is feasible for treating mitral lesions caused by infective endocarditis with good early and midterm outcomes. For patients who have severe preoperative conditions without serious valvular lesions, surgeons could try MVP.