Our Summary

The study looked at the results of mitral valve repair versus replacement in patients with active endocarditis, an infection of the inner layer of the heart. The research involved 247 patients who underwent surgery between 2006 and 2017. Of these, 114 had procedures done on the mitral valve due to an active infection.

The results showed that those who had a valve repair were less likely to be in the most severe class of heart failure. Both groups had similar heart function but also severe lung hypertension. The most common organism involved in the infection was streptococci and the average time from diagnosis to surgery was 11 days.

After surgery, 13.2% of the repair group had moderate to severe mitral regurgitation, but without recurrent endocarditis. The repair group also tended to have a better survival rate after 5 years (91.6% vs 70.0%). The need for re-operation was similar in both groups.

The study concludes that mitral valve repair during active endocarditis can be safely done with good mid-term results, particularly in patients without an extremely high surgical risk. Valve replacement was more likely in patients with severe heart failure and those requiring combined procedures.

FAQs

  1. What was the main focus of the study on mitral valve repair versus replacement?
  2. What were the key findings from the study regarding patient outcomes post-surgery?
  3. Was there a difference in the need for re-operation between the repair and replacement groups?

Doctor’s Tip

A helpful tip a doctor might tell a patient about valve replacement is to follow post-operative care instructions closely, including taking all prescribed medications, attending follow-up appointments, and participating in cardiac rehabilitation if recommended. It is important to listen to your body and report any new or worsening symptoms to your healthcare provider promptly. Additionally, maintaining a healthy lifestyle with regular exercise, a balanced diet, and avoiding smoking can help promote long-term success after valve replacement surgery.

Suitable For

Patients who are typically recommended valve replacement include those with severe heart failure, severe lung hypertension, and those requiring combined procedures. Additionally, patients with active endocarditis, particularly those with a high surgical risk, may also be recommended valve replacement. It is important to consider the individual patient’s specific medical condition and risk factors when determining the most appropriate treatment option.

Timeline

In summary, a patient who undergoes valve replacement due to active endocarditis can expect to experience a diagnosis of the infection, a decision on whether repair or replacement is necessary, and then undergo surgery within a short timeframe. After surgery, there may be some complications such as mitral regurgitation, but overall the patient can expect improved heart function and a better survival rate compared to those who undergo valve repair. Regular follow-up care will be needed to monitor the valve and ensure optimal outcomes.

What to Ask Your Doctor

  1. What are the risks and benefits of mitral valve repair versus replacement in my specific case?
  2. What is the expected recovery time and rehabilitation process for each type of surgery?
  3. How will the choice between repair and replacement affect my long-term heart function and overall health?
  4. What is the likelihood of needing a re-operation in the future with either option?
  5. How will the choice between repair and replacement impact my quality of life and ability to perform daily activities?
  6. Are there any alternative treatment options to consider before making a decision on valve repair or replacement?
  7. What is the success rate of mitral valve repair in patients with active endocarditis, and how does it compare to valve replacement?
  8. What is the average survival rate for patients who undergo mitral valve repair or replacement for active endocarditis?
  9. How important is it to have the surgery done quickly after diagnosis of endocarditis, and how does timing impact the success of the procedure?
  10. Are there any specific post-operative care instructions or lifestyle changes I should follow after undergoing mitral valve repair or replacement for active endocarditis?

Reference

Authors: Tepsuwan T, Rimsukcharoenchai C, Tantraworasin A, Taksaudom N, Woragidpoonpol S, Chuaratanaphong S, Nawarawong W. Journal: Gen Thorac Cardiovasc Surg. 2019 Dec;67(12):1030-1037. doi: 10.1007/s11748-019-01132-4. Epub 2019 May 2. PMID: 31049817