Valve repair is the treatment of choice for native mitral valve regurgitation. The feasibility of repair when the defect is caused by acute infective endocarditis (IE) is debated. This study aims to compare the outcome of repair and replacement procedures, to report the rate of repair in a single surgical center, and to review the literature on this topic. We retrospectively analyzed 108 patients with native mitral IE, potentially eligible for surgical repair. Of these 108, 90 (83%) underwent surgery, and 18 were treated conservatively. Among the 90 surgical patients, 57 (63%) underwent valve replacement and 33 valve repair (37%). The mean follow-up duration was 3 years. The two primary endpoints were mortality and freedom from recurrent endocarditis. Secondary endpoints were the post-operative incidence of major adverse events (hospitalization for any cause, pacemaker implantation, new onset of atrial fibrillation, sternal dehiscence), left ventricular systolic function (LVSF), and valvular function at 1-year echocardiographic follow-up. All-cause mortality was lower for valve repair, although not significantly (p = 0.86), as well as nonfatal adverse events (p = 0.92) and relapse rate (p = 0.20) at 3 years. We did not find differences between the two groups at echocardiographic follow-up, neither for left ventricular systolic function (p = 0.22), nor for valvular continence (p = 0.28). In our experience, the mid-term outcome of repair in IE is comparable to valve replacement and should be considered whenever possible, as in degenerative valve disease. The review of the literature supports this strategy.

中文翻译：

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感染性心内膜炎患者二尖瓣修复的可行性和结果

瓣膜修复是天然二尖瓣返流的治疗选择。对于由急性感染性心内膜炎（IE）引起的缺损修复的可行性存在争议。本研究旨在比较修复和置换程序的结果，报告单个手术中心的修复率，并复习有关该主题的文献。我们回顾性分析了108例具有天然二尖瓣IE的患者，这些患者有资格进行手术修复。在这108名患者中，有90名（83％）接受了手术，其中18名接受了保守治疗。在90例外科手术患者中，有57例（63％）进行了瓣膜置换，33例进行了瓣膜修复（37％）。平均随访时间为3年。两个主要终点是死亡率和无复发性心内膜炎。次要终点是术后1年超声心动图检查中的主要不良事件（因任何原因住院，起搏器植入，新发房颤，胸骨裂开），左心室收缩功能（LVSF）和瓣膜功能的术后发生率。瓣膜修复的全因死亡率较低，尽管不显着（p = 0.86），以及非致命不良事件（p = 0.92）和3年复发率（p = 0.20）。我们在超声心动图随访中未发现两组之间的差异，左心室收缩功能（p = 0.22）或瓣膜性尿失禁（p = 0.28）。根据我们的经验，IE修复的中期结果与瓣膜置换术相当，应尽可能考虑使用，如变性瓣膜病。