Minimally Invasive Surgery in Mitral Valve Endocarditis
14 January 2018
10 September 2018
31 October 2018 (online)
Background To minimize the surgical damage, minimally invasive mitral valve surgery (MIMVS) has become the therapy of choice. However, this approach is technically more challenging, especially in endocarditis. The data on MIMVS in endocarditis are scarce, we therefore retrospectively analyzed the result at our institute.
Methods From January 2011 and July 2017, 420 MIMVS were performed, out of which 44 (10%) were for endocarditis. Mean age was 55 ± 17 years and 41% (n = 18) were male.
Results Euroscore II was 7.3 (range: 2–38). Operation times, cardiopulmonary bypass times, and clamp times were 230 (±77), 158 (±56), and 84 (±39) minutes, respectively. Seven cases (16%) were cardiac redo operations. Mitral valve repair and replacement was performed in 46 (n = 20) and 54% (n = 24) of patients, respectively. Overall in-hospital mortality, apoplexy, and reoperation rates (all for bleeding) were 7 (n = 3), 0 (n = 0), and 11% (n = 5), respectively. New onset of dialysis was required in three patients (7%). No patient developed superficial wound infection. Overall intensive care unit and hospital stay was 3 (±3) and 24 (±32) days, respectively.
Conclusion MIMVS can be performed with acceptable outcome and low perioperative morbidity in patients with mitral valve endocarditis. Especially absence of any postoperative wound infections and low rate of endocarditis recurrence; use of MIMVS must be encouraged as an eligible approach in most cases.
In a setting of endocarditis, these often multimorbid patients require a close collaboration for their individual treatment intra- as well as postoperatively, and a lot of effort concerning the optimal therapeutic strategy has to be applied. Accordingly, to further evaluate these patients to publish the data, different departments have to closely collaborate. Therefore, the authors of this publication exceed the maximum of seven.
J.S. was involved in data collection and writing of the manuscript. F.F. was involved in data evaluation, writing of the manuscript, revision of the paper, statistical analysis, and designing of the study. J.N. was mainly responsible for data collection as part of his doctoral thesis. M.A. and G.W. were responsible for designing of the study and were performing operations and involved in the review of the manuscript as well as statistical evaluation. S.Z. and C.K. were involved in the evaluation of the microbiological data as experts in endocarditis. J.M. was involved in data collection and responsible for the figures. S.C. and A.H. were involved in designing the study as well as performing the operations. I.T. was responsible as senior author for data evaluation, writing of the manuscript, as well as revision, and performed the operations.
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