The early and midterm clinical outcomes of mitral valvuloplasty versus replacement for infective endocarditis: A propensity score matching study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

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;

Corresponding author：

JIAN Xuhua, Email: jianxuhua@gdph.org.cn

Keywords：

Infective endocarditis; mitral regurgitation; mitral valvuloplasty; mitral valve replacement; EuroSCORE-Ⅱ

DOI：

10.7507/1007-4848.202310040

Video：

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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. According to the procedures, the patients were divided into a MVP group and 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 (120 males, 85.1%) and 54 patients in the MVR group (41 males, 75.9%). The mean follow-up time was (34.0±16.1) months. Patients in the MVP group were younger [(42.7±14.6) years vs. (56.8±13.0) years, P<0.001] and had better preoperative conditions. The patients in the MVP group had a shorter ICU stay [3.0 (2.0, 5.0) d vs. 4.0 (3.0, 8.0) d, P=0.004], 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 baseline data or 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 or 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 with severer preoperative conditions, if the leaflet damage is not severe, MVP may be a viable option, but validation with larger sample sizes is needed.

1.	中华医学会胸心血管外科分会瓣膜病外科学组. 感染性心内膜炎外科治疗中国专家共识. 中华胸心血管外科杂志, 2022, 38(3): 146-155.Group of Valve Surgery, Chinese Society for Thoracic and Cardiovascular Surgery. Chinese expert consensus on surgical treatment of infective endocarditis . Chin J Thorac Cardiovasc Surg, 2022, 38(3): 146-155.
2.	Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
3.	Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.
4.	Toyoda N, Itagaki S, Egorova NN, et al. Real-world outcomes of surgery for native mitral valve endocarditis. J Thorac Cardiovasc Surg, 2017, 154(6): 1906-1912.
5.	Østergaard L, Valeur N, Wang A, et al. Incidence of infective endocarditis in patients considered at moderate risk. Eur Heart J, 2019, 40(17): 1355-1361.
6.	Ambrosioni J, Hernández-Meneses M, Durante-Mangoni E, et al. Epidemiological changes and improvement in outcomes of infective endocarditis in Europe in the twenty-first century: an International Collaboration on Endocarditis (ICE) prospective cohort study (2000-2012). Infect Dis Ther, 2023, 12(4): 1083-1101.
7.	Moreillon P, Que YA. Infective endocarditis. Lancet, 2004, 363(9403): 139-149.
8.	Bakaeen FG, Shroyer AL, Zenati MA, et al. Mitral valve surgery in the US Veterans Administration Health System: 10-year outcomes and trends. J Thorac Cardiovasc Surg, 2018, 155(1): 105-117.
9.	Ng Yin Ling C, Bleetman D, Pal S, et al. Should more patients be offered repair for mitral valve endocarditis? A single-centre 15-year experience. J Cardiothorac Surg, 2022, 17(1): 243.
10.	Lee HA, Cheng YT, Wu VC, et al. Nationwide cohort study of mitral valve repair versus replacement for infective endocarditis. J Thorac Cardiovasc Surg, 2018, 156(4): 1473-1483.
11.	Solari S, De Kerchove L, Tamer S, et al. Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable? Eur J Cardiothorac Surg, 2019, 55(2): 256-262.
12.	刘辉, 刘剑萍, 张海英, 等. EuroSCORE评分对心脏瓣膜手术患者死亡风险的预测. 四川医学, 2016, 37(4): 375-378.Liu H, Liu JP, Zhang HY, et al. Validation of EuroSCORE in patients undergoing cardiac valve surgery. Sichuan Med J, 2016, 37(4): 375-378.
13.	Liu X, Miao Q, Liu X, et al. Repair versus replacement for active endocarditis of the mitral valve: 9 years of experience. J Card Surg, 2022, 37(11): 3713-3719.
14.	Tepsuwan T, Rimsukcharoenchai C, Tantraworasin A, et al. Comparison between mitral valve repair and replacement in active infective endocarditis. Gen Thorac Cardiovasc Surg, 2019, 67(12): 1030-1037.
15.	Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation, 2015, 132(15): 1435-1486.
16.	Scheggi V, Olivotto I, Del Pace, et al. Feasibility and outcome of mitral valve repair in patients with infective endocarditis. Cardiothorac Surg, 2020, 28: 27.
17.	Cuerpo GP, Valerio M, Pedraz A, et al. Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry. Gen Thorac Cardiovasc Surg, 2019, 67(7): 585-593.
18.	周天羽, 李军, 赖颢, 等. 二尖瓣修复术和二尖瓣置换术治疗感染性心内膜炎二尖瓣反流的中远期疗效比较. 中华胸心血管外科杂志, 2017, 33(7): 408-412.Zhou TY, Li J, Lai H, et al. Mitral valve repair and mitral valve replacement in the treatment of infective endocarditis mitral valve regurgitation in the long-term curative effect comparison. Chin J Thorac Cardiovasc Surg, 2017, 33(7): 408-412.
19.	郑帅, 焦玉清, 张海波, 等. 自体瓣膜心内膜炎二尖瓣成形与二尖瓣置换远期疗效的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(3): 193-197.Zheng S, Jiao YQ, Zhang HB, et al. Long-term outcomes following mitral valvuloplastyversus replacement for native valve endocarditis: a case control study. Chin J Clin Thorac Cardiovasc Surg, 2018, 25(3): 193-197.
20.	Miura T, Hamawaki M, Hazama S, et al. Outcome of surgical management for active mitral native valve infective endocarditis: a collective review of 57 patients. Gen Thorac Cardiovasc Surg, 2014, 62(8): 488-498.
21.	Moore RA, Witten JC, Lowry AM, et al. Isolated mitral valve endocarditis: patient, disease, and surgical factors that influence outcomes. J Thorac Cardiovasc Surg, 2024, 167(1): 127-140.
22.	Defauw RJ, Tomšič A, van Brakel TJ, et al. A structured approach to native mitral valve infective endocarditis: is repair better than replacement? Eur J Cardiothorac Surg, 2020, 58(3): 544-550.

1. 中华医学会胸心血管外科分会瓣膜病外科学组. 感染性心内膜炎外科治疗中国专家共识. 中华胸心血管外科杂志, 2022, 38(3): 146-155.Group of Valve Surgery, Chinese Society for Thoracic and Cardiovascular Surgery. Chinese expert consensus on surgical treatment of infective endocarditis . Chin J Thorac Cardiovasc Surg, 2022, 38(3): 146-155.
2. Nishimura RA, Otto CM, Bonow RO, et al. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association task force on clinical practice guidelines. J Am Coll Cardiol, 2017, 70(2): 252-289.
3. Delgado V, Ajmone Marsan N, de Waha S, et al. 2023 ESC guidelines for the management of endocarditis. Eur Heart J, 2023, 44(39): 3948-4042.
4. Toyoda N, Itagaki S, Egorova NN, et al. Real-world outcomes of surgery for native mitral valve endocarditis. J Thorac Cardiovasc Surg, 2017, 154(6): 1906-1912.
5. Østergaard L, Valeur N, Wang A, et al. Incidence of infective endocarditis in patients considered at moderate risk. Eur Heart J, 2019, 40(17): 1355-1361.
6. Ambrosioni J, Hernández-Meneses M, Durante-Mangoni E, et al. Epidemiological changes and improvement in outcomes of infective endocarditis in Europe in the twenty-first century: an International Collaboration on Endocarditis (ICE) prospective cohort study (2000-2012). Infect Dis Ther, 2023, 12(4): 1083-1101.
7. Moreillon P, Que YA. Infective endocarditis. Lancet, 2004, 363(9403): 139-149.
8. Bakaeen FG, Shroyer AL, Zenati MA, et al. Mitral valve surgery in the US Veterans Administration Health System: 10-year outcomes and trends. J Thorac Cardiovasc Surg, 2018, 155(1): 105-117.
9. Ng Yin Ling C, Bleetman D, Pal S, et al. Should more patients be offered repair for mitral valve endocarditis? A single-centre 15-year experience. J Cardiothorac Surg, 2022, 17(1): 243.
10. Lee HA, Cheng YT, Wu VC, et al. Nationwide cohort study of mitral valve repair versus replacement for infective endocarditis. J Thorac Cardiovasc Surg, 2018, 156(4): 1473-1483.
11. Solari S, De Kerchove L, Tamer S, et al. Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable? Eur J Cardiothorac Surg, 2019, 55(2): 256-262.
12. 刘辉, 刘剑萍, 张海英, 等. EuroSCORE评分对心脏瓣膜手术患者死亡风险的预测. 四川医学, 2016, 37(4): 375-378.Liu H, Liu JP, Zhang HY, et al. Validation of EuroSCORE in patients undergoing cardiac valve surgery. Sichuan Med J, 2016, 37(4): 375-378.
13. Liu X, Miao Q, Liu X, et al. Repair versus replacement for active endocarditis of the mitral valve: 9 years of experience. J Card Surg, 2022, 37(11): 3713-3719.
14. Tepsuwan T, Rimsukcharoenchai C, Tantraworasin A, et al. Comparison between mitral valve repair and replacement in active infective endocarditis. Gen Thorac Cardiovasc Surg, 2019, 67(12): 1030-1037.
15. Baddour LM, Wilson WR, Bayer AS, et al. Infective endocarditis in adults: Diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation, 2015, 132(15): 1435-1486.
16. Scheggi V, Olivotto I, Del Pace, et al. Feasibility and outcome of mitral valve repair in patients with infective endocarditis. Cardiothorac Surg, 2020, 28: 27.
17. Cuerpo GP, Valerio M, Pedraz A, et al. Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish nationwide prospective registry. Gen Thorac Cardiovasc Surg, 2019, 67(7): 585-593.
18. 周天羽, 李军, 赖颢, 等. 二尖瓣修复术和二尖瓣置换术治疗感染性心内膜炎二尖瓣反流的中远期疗效比较. 中华胸心血管外科杂志, 2017, 33(7): 408-412.Zhou TY, Li J, Lai H, et al. Mitral valve repair and mitral valve replacement in the treatment of infective endocarditis mitral valve regurgitation in the long-term curative effect comparison. Chin J Thorac Cardiovasc Surg, 2017, 33(7): 408-412.
19. 郑帅, 焦玉清, 张海波, 等. 自体瓣膜心内膜炎二尖瓣成形与二尖瓣置换远期疗效的病例对照研究. 中国胸心血管外科临床杂志, 2018, 25(3): 193-197.Zheng S, Jiao YQ, Zhang HB, et al. Long-term outcomes following mitral valvuloplastyversus replacement for native valve endocarditis: a case control study. Chin J Clin Thorac Cardiovasc Surg, 2018, 25(3): 193-197.
20. Miura T, Hamawaki M, Hazama S, et al. Outcome of surgical management for active mitral native valve infective endocarditis: a collective review of 57 patients. Gen Thorac Cardiovasc Surg, 2014, 62(8): 488-498.
21. Moore RA, Witten JC, Lowry AM, et al. Isolated mitral valve endocarditis: patient, disease, and surgical factors that influence outcomes. J Thorac Cardiovasc Surg, 2024, 167(1): 127-140.
22. Defauw RJ, Tomšič A, van Brakel TJ, et al. A structured approach to native mitral valve infective endocarditis: is repair better than replacement? Eur J Cardiothorac Surg, 2020, 58(3): 544-550.

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