Minimally Invasive Mitral Valve Surgery in Mitral Valve Endocarditis: A Single-Center Experience

Background: Minimally invasive mitral valve surgery (MIMVS) is the gold standard for mitral valve pathologies; however, it is technically more challenging especially in patients with endocarditis. Here, we compare the early postoperative outcome of patients with endocarditis and other indications for MIMVS.

Methods: Two groups were formed, one consisting of patients who underwent surgery because of mitral valve endocarditis (study group: n = 73) and the other group consisting of patients who had another indication for MIMVS (control group: n = 819). Patients were observed for 30 postoperative days and 30-day mortality was considered as primary endpoint.

Results: Data were retrospectively reviewed and collected from January 2011 until December 2022. Patients from the study group were younger (60 vs. 68 years; p < 0.001) and had a higher preoperative incidence of stroke (26% vs. 6%; p < 0.001) with neurological symptoms (26% vs. 9%; p < 0.001). The repair rate was lower in the study group (45% vs. 64%; p = 0.003) and mechanical valves were more often used in the study group in case of replacement (25% vs. 11%; p < 0.001). No difference was seen in overall surgery time (211 vs. 206 minutes; p = 0.71), time on cardiopulmonary bypass (137 vs. 137 minutes; p = 0.42) and aortic clamping time (76 vs. 78 minutes; p = 0.42). Concerning postoperative data, the study group had a higher requirement of erythrocyte transfusion (2 vs. 0; p = 0.041). But no difference was seen in the need for a mitral valve redo-procedure (4% vs. 1%; p = 0.09), bleeding (12% vs. 7%; p = 0.16), stroke (3% vs. 2%; p = 0.38), cerebral bleeding (1% vs. 0%; p = 0.31), new onset dialysis (5% vs. 3%; p = 0.32), overall intubation time (11 vs. 11 hours; p = 0.13), sepsis (1% vs. 2%; p = 1), pacemaker implantation (1% vs. 6%; p = 0.11), wound healing disorders (4% vs. 6%; p = 0.47) and 30-day mortality (4% vs. 2%; p = 0.42).

Conclusion: Minimally invasive mitral valve surgery in patients with mitral valve endocarditis was feasible with a low early postoperative mortality. Despite a higher preoperative prevalence of stroke and neurological symptoms, postoperative stroke and intracerebral bleeding incidences remained low.