The Role of Microbes in Surgical Decision Making for Infective Endocarditis: Mitral Valve Repair or Replacement?

被引:1
作者
Mikus, Elisa [1 ]
Fiorentino, Mariafrancesca [1 ]
Sangiorgi, Diego [1 ]
Pascale, Renato [2 ,3 ]
Costantino, Antonino [1 ]
Nocera, Chiara [4 ]
Calvi, Simone [1 ]
Tenti, Elena [1 ]
Tremoli, Elena [1 ]
Tripodi, Alberto [1 ]
Savini, Carlo [1 ,5 ]
机构
[1] Maria Cecilia Hosp, Cardiovasc Dept, GVM Care & Res, I-48033 Cotignola, Ravenna, Italy
[2] Alma Mater Studiorum Univ Bologna, Dept Med & Surg Sci, I-40138 Bologna, Italy
[3] IRCCS Azienda Osped Univ Bologna, Dept Integrated Infect Risk Management, Infect Dis Unit, I-40138 Bologna, Italy
[4] IRCCS Azienda Osped Univ Bologna, Cardiac Surg Dept, I-40138 Bologna, Italy
[5] Univ Bologna, Dept Expt Diagnost & Surg Med DIMEC, I-40126 Bologna, Italy
关键词
bacterial endocarditis; mitral valve; cardiac surgical procedures; mitral valve repair; mitral valve replacement; SURGERY;
D O I
10.3390/microorganisms12071320
中图分类号
Q93 [微生物学];
学科分类号
071005 ; 100705 ;
摘要
Background: The benefits of mitral repair versus replacement for endocarditis are inconclusive. This study compares outcomes of patients with infective endocarditis undergoing mitral valve repair versus replacement and investigates the impact of microbial etiology. Methods: All 251 patients undergoing mitral valve surgery for active endocarditis between 2010 and 2023 were enrolled, 180 (71.7%) replacement and 71 (28.3%) repair. To adjust for imbalances, inverse probability of treatment weighting was applied and 187 patients were obtained. Results: The analysis between groups, following the application of inverse probability of treatment weighting, showed no statistically significant differences across all considered outcomes. Early and late death was observed respectively in 6 (8.5%) and 11 (15.5%) patients in the repair group versus 24 (13.3%) and 45 (25.0%) in the replacement group without statistical significance (p = 0.221 and p = 0.446). Relapse occurred in six patients (8.5%) in the repair group after a median time of 4.0 months and in six (3.3%) in the replacement after 6.9 months (p = 0.071). Conclusions: Surgical strategy in mitral endocarditis has no effect on major postoperative complications, mortality, or medium/long-term survival. Staphylococcus aureus and Coagulase-negative Staphylococci represent a risk for early mortality and relapse. However, mitral valve repair for endocarditis can be pursued when it ensures the complete eradication of all infected tissue, particularly in cases caused by Streptococcus infection, in young patients, and after a minimum of 18 days of antibiotic therapy.
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页数:11
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