Minimally Invasive Mitral Valve Surgery for Mitral Valve Infective Endocarditis
05 March 2017
06 June 2017
27 July 2017 (online)
Background The feasibility of minimally invasive mitral valve (MV) surgery in infective endocarditis (IE) has not been reported in detail. We assessed the safety, efficacy, and durability of the minimally invasive approach through a right anterolateral minithoracotomy for surgical treatment of MV IE.
Methods A review of the Leipzig Heart Center database revealed 92 eligible patients operated on between 2002 and 2013. All patients had undergone minimally invasive surgery for IE. The indication for surgery was isolated IE of the MV in all patients. Baseline and intraoperative data, as well as clinical outcomes and short-term follow-up were analyzed retrospectively.
Results The patients' mean age was 60.9 ± 15.3 years, the logistic EuroSCORE II was 19.6 ± 19.1%, and 64.1% (59) were male. MV repair was feasible in 23.9% (22/92) of patients. Repair techniques included annuloplasty ring implantation, anterior mitral leaflet resection, posterior mitral leaflet resection, and implantation of neochordae. MV replacement was performed in 69 patients (75%), a mitral annulus patch in 1 patient, and concomitant tricuspid valve surgery for tricuspid regurgitation in 5 patients. Bacteriological analysis showed staphylococcus infection in 45.5%, streptococcus in 36.4%, enterococcus in 13.6%, and others in 4.5%. The 30-day-mortality rate was 9.8% (9 patients). The 1-year follow-up showed a 1-year survival rate of 77.7 ± 4.4% and freedom from reoperation within 1 year due to reendocarditis of 93.3 ± 2.1%.
Conclusions The minimally invasive approach is suitable for the treatment of IE of the MV. It is a good technique in IE in selected patients.
There was no financial support.
Parts were presented at the Scientific Sessions of the Mitral Conclave 2015 of the American Association for Thoracic Surgery as oral presentation on Thursday, April 23, 2015, New York, New York, United States.
- 1 Vollroth M, Seeburger J, Garbade J. , et al. Minimally invasive mitral valve surgery is a very safe procedure with very low rates of conversion to full sternotomy. Eur J Cardiothorac Surg 2012; 42 (01) e13-e15 , e16
- 2 Modi P, Rodriguez E, Hargrove III WC, Hassan A, Szeto WY, Chitwood Jr WR. Minimally invasive video-assisted mitral valve surgery: a 12-year, 2-center experience in 1178 patients. J Thorac Cardiovasc Surg 2009; 137 (06) 1481-1487
- 3 Seeburger J, Borger MA, Falk V. , et al. Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg 2008; 34 (04) 760-765
- 4 Gammie JS, Zhao Y, Peterson ED, O'Brien SM, Rankin JS, Griffith BP. J. Maxwell Chamberlain Memorial Paper for adult cardiac surgery. Less-invasive mitral valve operations: trends and outcomes from the Society of Thoracic Surgeons Adult Cardiac Surgery Database. Ann Thorac Surg 2010; 90 (05) 1401-1408 , 1410.e1, discussion 1408–1410
- 5 Nifong LW, Rodriguez E, Chitwood Jr WR. 540 consecutive robotic mitral valve repairs including concomitant atrial fibrillation cryoablation. Ann Thorac Surg 2012; 94 (01) 38-42 , discussion 43
- 6 Habib G, Hoen B, Tornos P. , et al; ESC Committee for Practice Guidelines; Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2009; 30 (19) 2369-2413
- 7 Vahanian A, Alfieri O, Andreotti F. , et al; ESC Committee for Practice Guidelines (CPG); Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC); European Association for Cardio-Thoracic Surgery (EACTS). Guidelines on the management of valvular heart disease (version 2012): the Joint Task Force on the Management of Valvular Heart Disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur J Cardiothorac Surg 2012; 42 (04) S1-S44
- 8 Guida M, Pecora G, Borzellino D, Borzellino R. Aortic valve replacement for acute endocarditis via a right anterior small thoracotomy (RAST). J Card Surg 2008; 23 (05) 546-547
- 9 Mohammadi S, Voisine P, Mathieu P, Dagenais F. Use of the endoclamp device in a patient with a native mitral valve endocarditis and a previous arch replacement with a modified Griepp technique. J Thorac Cardiovasc Surg 2006; 131 (05) 1188-1190
- 10 Masroor S, Berkowitz R, Nejad K, Alexander JC. Hybrid percutaneous coronary intervention and minimally invasive reoperative mitral valve surgery. J Card Surg 2009; 24 (02) 191-193
- 11 Feringa HH, Shaw LJ, Poldermans D. , et al. Mitral valve repair and replacement in endocarditis: a systematic review of literature. Ann Thorac Surg 2007; 83 (02) 564-570
- 12 Doukas G, Oc M, Alexiou C, Sosnowski AW, Samani NJ, Spyt TJ. Mitral valve repair for active culture positive infective endocarditis. Heart 2006; 92 (03) 361-363
- 13 Jung SH, Je HG, Choo SJ, Song H, Chung CH, Lee JW. Surgical results of active infective native mitral valve endocarditis: repair versus replacement. Eur J Cardiothorac Surg 2011; 40 (04) 834-839
- 14 Musci M, Hübler M, Pasic M. , et al. Surgery for active infective mitral valve endocarditis: a 20-year, single-center experience. J Heart Valve Dis 2010; 19 (02) 206-214 , discussion 215
- 15 Dreyfus G, Serraf A, Jebara VA. , et al. Valve repair in acute endocarditis. Ann Thorac Surg 1990; 49 (05) 706-711 , discussion 712–713
- 16 Zegdi R, Debièche M, Latrémouille C. , et al. Long-term results of mitral valve repair in active endocarditis. Circulation 2005; 111 (19) 2532-2536
- 17 de Kerchove L, Vanoverschelde JL, Poncelet A. , et al. Reconstructive surgery in active mitral valve endocarditis: feasibility, safety and durability. Eur J Cardiothorac Surg 2007; 31 (04) 592-599
- 18 Oberbach A, Schlichting N, Feder S. , et al. New insights into valve-related intramural and intracellular bacterial diversity in infective endocarditis. PLoS One 2017; 12 (04) e0175569