Management of commissural lesions in native mitral valve endocarditis:: Long-term results of valve repair and partial homograft replacement

Background and aim of the study: Commissural lesions in the context of native mitral valve endocarditis are a technically challenging condition for conservative surgery. Herein are reported the authors' 10-year results for mitral valve repair (MVRep) or partial homograft replacement (PHR) performed in this setting. Methods: Data were reviewed from 19 consecutive patients who underwent MVRep using either Carpentier's technique (n = 14) or PHR (n = 5) for endocarditis at the authors' institution between 1989 and 1994. Results: There was one operative death (5%; 95% CI 0-15.5%). Two reoperations were performed in each subgroup for recurrence of endocarditis (n = 2) and mitral valve failure (n = 2). The 10-year survival rate and freedom from mitral valve reoperation were 95% (95% CI 84-100%) and 78% (95% CI 59-97%), respectively. At 10 years, 13 (93%) surviving and non-reoperated patients were in good functional status (NYHA class I-II), and 14 (100%) were in sinus rhythm. Although echocardiographic results were excellent in the MVRep group, all PHR patients had moderate or severe mitral valve dysfunction. Conclusion: Commissural reconstruction using Carpentier's techniques demonstrated excellent long-term results in patients with native mitral valve endocarditis. In contrast, the results for PHR were rather disappointing.