Minimal access surgery for mitral valve endocarditis

作者：Barbero Cristina; Marchetto Giovanni; Ricci Davide; Mancuso Samuel; Boffini Massimo; Cecchi Enrico; De Rosa Francesco Giuseppe; Rinaldi Andmauro

来源：Interactive Cardiovascular and Thoracic Surgery, 2017, 25(2): 241-245.

DOI：10.1093/icvts/ivx088

• Infective endocarditis
• Valve replacement
• Mini-thoracotomy

OBJECTIVES: Minimal access mitral valve surgery (MVS) has already proved to be feasible and effective with low perioperative mortality and excellent long-term outcomes. However, experience in more complex valve diseases such as infective endocarditis (IE) still remains limited. The aim of this retrospective study was to evaluate early and long-term results of minimal access MVS for IE.
METHODS: Data were entered into a dedicated database. Analysis was performed retrospectively for the 8-year period between January 2007 and April 2015.
RESULTS: During the study period, 35 consecutive patients underwent minimal access MVS for IE at our department. Twenty-four had diagnosis of native MV endocarditis (68.6%) and 11 of mitral prosthesis endocarditis (31.4%). Thirty patients underwent early MVS (85.7%), and 5 patients were operated after the completion of antibiotic treatment (14.3%). Seven patients underwent MV repair (20%), 17 patients underwent MV replacement (48.6%), and 11 patients underwent mitral prosthesis replacement (31.4%). Thirty-day mortality was 11.4% (4 patients). No neurological or vascular complications were reported. One patient underwent reoperation for prosthesis IE relapse after 37 days. Overall actuarial survival rate at 1 and 5 years was 83%; freedom from MV reoperation and/or recurrence of IE at 1 and 5 years was 97%.
CONCLUSIONS: Minimally invasive MVS for IE is feasible and associated with good early and long-term results. Preoperative accurate patient selection and transoesophageal echocardiography evaluation is mandatory for surgical planning.

• 出版日期2017-8