ArticleThe Annals of thoracic surgery2026
Longitudinal Outcomes of Mitral Valve Surgery for Infective Endocarditis Within a Repair-First Strategy.
Article in The Annals of thoracic surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundMitral valve (MV) infective endocarditis (IE) often necessitates surgical intervention for severe mitral regurgitation, yet the longitudinal impact of MV surgery within a repair-first strategy remains unclear.
methodsAn institutional multidisciplinary endocarditis database incorporating The Society of Thoracic Surgeons data identified patients undergoing MV surgery for acute IE between July 2016 and June 2024. Cases were managed with a repair-first operative strategy, with MV replacement reserved for patients in whom repair was not feasible. Primary outcomes were survival and the composite of reinfection, reoperation, or death. Secondary measures included perioperative outcomes and the individual components of the composite.
resultsA total of 198 patients underwent first-time MV intervention for IE (repair, 102 [51.5%]) or replacement, 96 [48.5%]). The repair group was younger (45 vs 51 years; P = .03) and had fewer prior non-MV cardiac surgeries (18.6% vs 34.4%; P = .01). The repair group had less prolonged ventilation (14.7% vs 32.3%; P = .003) and shorter intensive care unit stay (73 vs 121 hours; P < .0001). MV repair was associated with superior risk-adjusted survival (hazard ratio, 0.49; P = .01) and freedom from the composite outcome of reoperation, reinfection, or death (hazard ratio, 0.27; P < .001).
conclusionsComplex MV repair (defined as leaflet modification or patch reconstruction) in acute IE is safe and durable. Within a repair-first strategy, successful repair was associated with favorable perioperative recovery and improved midterm outcomes. These findings support a repair-first approach when it is anatomically and technically feasible.
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