Research progress of mitral valvuloplasty in patients with infective endocarditis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

GAN Lixi ¹ , CHEN Oudi ² , CHEN Fanyu ³ , WANG Weiteng ¹ , QING Hongkun ³ , LI Xin ³ ,  JIAN Xuhua ³

1. Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, 510010, P. R. China;
2. Department of Echocardiography, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510010, P. R. China;
3. Department of Cardiac Surgery, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Southern Medical University, Guangzhou, 510010, P. R. China;

Corresponding author：

JIAN Xuhua, Email: jianxuhua@gdph.org.cn

Keywords：

Infective endocarditis; mitral valvuloplasty; review

DOI：

10.7507/1007-4848.202306019

Video：

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Infective endocarditis is one of the severest valvar diseases, commonly affecting the mitral valve. Currently, valvuloplasty and replacement are the main surgical options for mitral infective endocarditis. However, the complexity of the infectious lesions has caused a raging debate on which surgical approach offers more benefits. With the development of surgical treatment for endocarditis, mitral valvuloplasty may be a superior solution. It can preserve the integrity of the valve structure, avoiding complications caused by replacement. However, there is a lack of evidence from randomized clinical trials and other evidence-based medical supports. Furthermore, issues regarding the timing of surgery, repair methods, and material choices for mitral valvuloplasty in these patients have not been standardized. Therefore, this article summarizes existing literature to assist clinicians in making appropriate treatment decisions.

1.	中华医学会胸心血管外科分会瓣膜病外科学组. 感染性心内膜炎外科治疗中国专家共识. 中华胸心血管外科杂志, 2022, 38(3): 146-155.Group of Valve Surgery, Chinses Society for Thoracic and Cardiovascular Surgery. Chinese expert consensus on surgical treatment of infective endocarditis. Chin J Thorac Cardiovasc Surg, 2022, 38(3): 146-155.
2.	AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs, Pettersson GB, Coselli JS, et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary. J Thorac Cardiovasc Surg, 2017, 153(6): 1241-1258.
3.	Toyoda N, Itagaki S, Egorova NN, et al. Real-world outcomes of surgery for native mitral valve endocarditis. J Thorac Cardiovasc Surg, 2017, 154(6): 1906-1912.
4.	Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med, 2009, 169(5): 463-473.
5.	Okada Y, Nakai T, Kitai T. Role of mitral valve repair for mitral infective endocarditis. Cardiol Clin, 2021, 39(2): 189-196.
6.	Dreyfus G, Serraf A, Jebara VA, et al. Valve repair in acute endocarditis. Ann Thorac Surg, 1990, 49(5): 706-711.
7.	Bakaeen FG, Shroyer AL, Zenati MA, et al. Mitral valve surgery in the US Veterans Administration Health System: 10-year outcomes and trends. J Thorac Cardiovasc Surg, 2018, 155(1): 105-117.
8.	Ng Yin Ling C, Bleetman D, Pal S, et al. Should more patients be offered repair for mitral valve endocarditis? A single-centre 15-year experience. J Cardiothorac Surg, 2022, 17(1): 243.
9.	Lee HA, Cheng YT, Wu VC, et al. Nationwide cohort study of mitral valve repair versus replacement for infective endocarditis. J Thorac Cardiovasc Surg, 2018, 156(4): 1473-1483.
10.	Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23): 2440-2492.
11.	Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015, 36(44): 3075-3128.
12.	周天羽, 李军, 赖颢, 等. 二尖瓣修复术和二尖瓣置换术治疗感染性心内膜炎二尖瓣反流的中远期疗效比较. 中华胸心血管外科杂志, 2017, 33(7): 408-412.Zhou TY, Li J, Lai H, et al. Mitral valve repair and mitral valve replacement in the treatment of infective endocarditis mitral valve regurgitation in the long-term curative effect comparison. Chin J Thorac Cardiovasc Surg, 2017, 33(7): 408-412.
13.	Liu X, Miao Q, Liu X, et al. Repair versus replacement for active endocarditis of the mitral valve: 9 years of experience. J Card Surg, 2022, 37(11): 3713-3719.
14.	Helmers MR, Fowler C, Kim ST, et al. Repair of isolated native mitral valve endocarditis: a propensity matched study. Semin Thorac Cardiovasc Surg, 2022, 34(2): 490-499.
15.	Oliver L, Leauthier M, Jamme M, et al. Mitral valve repair is better than mitral valve replacement in native mitral valve endocarditis: results from a prospective matched cohort. Arch Cardiovasc Dis, 2022, 115(3): 160-168.
16.	Moore RA, Witten JC, Lowry AM, et al. Isolated mitral valve endocarditis: patient, disease, and surgical factors that influence outcomes. J Thorac Cardiovasc Surg, 2024, 167(1): 127-140.e15.
17.	Roberts WC, Salam YM, Roberts CS. Morphologic findings in native mitral valves replaced for isolated acute infective endocarditis. Am J Cardiol, 2022, 162: 136-142.
18.	Solari S, Navarra E, de Kerchove L, et al. Mitral valve repair for endocarditis. J Card Surg, 2022, 37(12): 4097-4102.
19.	Defauw RJ, Tomšič A, van Brakel TJ, et al. A structured approach to native mitral valve infective endocarditis: is repair better than replacement? Eur J Cardiothorac Surg, 2020, 58(3): 544-550.
20.	Scheggi V, Olivotto I, Del Pace S, et al. Feasibility and outcome of mitral valve repair in patients with infective endocarditis. Cardiothorac Surg, 2020, 28(1): 1-10.
21.	Miura T, Obase K, Ariyoshi T, et al. Impact of lesion localization on durability of mitral valve repair in infective endocarditis. Ann Thorac Surg, 2020, 109(5): 1335-1342.
22.	Tepsuwan T, Rimsukcharoenchai C, Tantraworasin A, et al. Comparison between mitral valve repair and replacement in active infective endocarditis. Gen Thorac Cardiovasc Surg, 2019, 67(12): 1030-1037.
23.	Solari S, De Kerchove L, Tamer S, et al. Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable? Eur J Cardiothorac Surg, 2019, 55(2): 256-262.
24.	Cuerpo GP, Valerio M, Pedraz A, et al. Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish Nationwide Prospective Registry. Gen Thorac Cardiovasc Surg, 2019, 67(7): 585-593.
25.	El Gabry M, Haidari Z, Mourad F, et al. Outcomes of mitral valve repair in acute native mitral valve infective endocarditis. Interact Cardiovasc Thorac Surg, 2019, 29(6): 823-829.
26.	Lee HA, Lin CY, Chen YC, et al. Surgical interventions of isolated active mitral valve endocarditis: predisposing factors and impact of neurological insults on final outcome. Medicine (Baltimore), 2018, 97(11): e0054.
27.	白贵学. 二尖瓣成形术在感染性心内膜炎二尖瓣关闭不全治疗中的价值探析. 养生保健指南, 2018, 19: 20-21.Bai GX. Value analysis of mitral valvuloplasty in the treatment of mitral regurgitation caused by infective endocarditis. Health Guide, 2018, 19: 20-21.
28.	Tomšic A, Versteegh MIM, Ajmone Marsan N, et al. Early and late results of surgical treatment for isolated active native mitral valve infective endocarditis. Interact Cardiovasc Thorac Surg, 2018, 26(4): 610-616.
29.	Perrotta S, Fröjd V, Lepore V, et al. Surgical treatment for isolated mitral valve endocarditis: a 16-year single-centre experience. Eur J Cardiothorac Surg, 2018, 53(3): 576-581.
30.	Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J, 2009, 30(19): 2369-2413.
31.	Hu YN, Wan S. Repair of infected mitral valves: what have we learned? Surg Today, 2018, 48(10): 899-908.
32.	Siquier-Padilla J, Cuervo G, Urra X, et al. Optimal timing for cardiac surgery in infective endocarditis with neurological complications: a narrative review. J Clin Med, 2022, 11(18): 5275.
33.	Murai R, Funakoshi S, Kaji S, et al. Outcomes of early surgery for infective endocarditis with moderate cerebral complications. J Thorac Cardiovasc Surg, 2017, 153(4): 831-840.
34.	Samura T, Yoshioka D, Toda K, et al. Emergency valve surgery improves clinical results in patients with infective endocarditis complicated with acute cerebral infarction: analysis using propensity score matching. Eur J Cardiothorac Surg, 2019, 56(5): 942-949.
35.	Ruttmann E, Abfalterer H, Wagner J, et al. Endocarditis-related stroke is not a contraindication for early cardiac surgery: an investigation among 440 patients with left-sided endocarditis. Eur J Cardiothorac Surg, 2020, 58(6): 1161-1167.
36.	Musleh R, Schlattmann P, Caldonazo T, et al. Surgical timing in patients with infective endocarditis and with intracranial hemorrhage: a systematic review and meta-analysis. J Am Heart Assoc, 2022, 11(10): e024401.
37.	Yaftian N, Buratto E, Ye XT, et al. Long-term outcomes of mitral valve endocarditis: improved survival through collaborative management. ANZ J Surg, 2020, 90(5): 757-761.
38.	陈金淼, 何晨, 王春生, 等. 二尖瓣成形术治疗感染性心内膜炎(IE)的中长期疗效. 复旦学报(医学版), 2015, 42(1): 105-107, 118.Chen JM, He CM, Wang CS, et al. Mid-long term outcomes of mitral valve reconstruction for infective endocarditis (IE). Fudan Univ J Med Sci, 2015, 42(1): 105-107, 118.
39.	Pektok E, Sierra J, Cikirikcioglu M, et al. Midterm results of valve repair with a biodegradable annuloplasty ring for acute endocarditis. Ann Thorac Surg, 2010, 89(4): 1180-1185.
40.	Musci M, Hübler M, Amiri A, et al. Repair for active infective atrioventricular valve endocarditis: 23-year single center experience. Clin Res Cardiol, 2011, 100(11): 993-1002.
41.	Rostagno C, Carone E, Stefàno PL. Role of mitral valve repair in active infective endocarditis: long term results. J Cardiothorac Surg, 2017, 12(1): 29.
42.	Kanemitsu H, Nakamura K, Fukunaga N, et al. Long-term outcomes of mitral valve repair for active endocarditis. Circ J, 2016, 80(5): 1148-1152.

1. 中华医学会胸心血管外科分会瓣膜病外科学组. 感染性心内膜炎外科治疗中国专家共识. 中华胸心血管外科杂志, 2022, 38(3): 146-155.Group of Valve Surgery, Chinses Society for Thoracic and Cardiovascular Surgery. Chinese expert consensus on surgical treatment of infective endocarditis. Chin J Thorac Cardiovasc Surg, 2022, 38(3): 146-155.
2. AATS Surgical Treatment of Infective Endocarditis Consensus Guidelines Writing Committee Chairs, Pettersson GB, Coselli JS, et al. 2016 The American Association for Thoracic Surgery (AATS) consensus guidelines: surgical treatment of infective endocarditis: executive summary. J Thorac Cardiovasc Surg, 2017, 153(6): 1241-1258.
3. Toyoda N, Itagaki S, Egorova NN, et al. Real-world outcomes of surgery for native mitral valve endocarditis. J Thorac Cardiovasc Surg, 2017, 154(6): 1906-1912.
4. Murdoch DR, Corey GR, Hoen B, et al. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med, 2009, 169(5): 463-473.
5. Okada Y, Nakai T, Kitai T. Role of mitral valve repair for mitral infective endocarditis. Cardiol Clin, 2021, 39(2): 189-196.
6. Dreyfus G, Serraf A, Jebara VA, et al. Valve repair in acute endocarditis. Ann Thorac Surg, 1990, 49(5): 706-711.
7. Bakaeen FG, Shroyer AL, Zenati MA, et al. Mitral valve surgery in the US Veterans Administration Health System: 10-year outcomes and trends. J Thorac Cardiovasc Surg, 2018, 155(1): 105-117.
8. Ng Yin Ling C, Bleetman D, Pal S, et al. Should more patients be offered repair for mitral valve endocarditis? A single-centre 15-year experience. J Cardiothorac Surg, 2022, 17(1): 243.
9. Lee HA, Cheng YT, Wu VC, et al. Nationwide cohort study of mitral valve repair versus replacement for infective endocarditis. J Thorac Cardiovasc Surg, 2018, 156(4): 1473-1483.
10. Nishimura RA, Otto CM, Bonow RO, et al. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation, 2014, 129(23): 2440-2492.
11. Habib G, Lancellotti P, Antunes MJ, et al. 2015 ESC guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European Association of Nuclear Medicine (EANM). Eur Heart J, 2015, 36(44): 3075-3128.
12. 周天羽, 李军, 赖颢, 等. 二尖瓣修复术和二尖瓣置换术治疗感染性心内膜炎二尖瓣反流的中远期疗效比较. 中华胸心血管外科杂志, 2017, 33(7): 408-412.Zhou TY, Li J, Lai H, et al. Mitral valve repair and mitral valve replacement in the treatment of infective endocarditis mitral valve regurgitation in the long-term curative effect comparison. Chin J Thorac Cardiovasc Surg, 2017, 33(7): 408-412.
13. Liu X, Miao Q, Liu X, et al. Repair versus replacement for active endocarditis of the mitral valve: 9 years of experience. J Card Surg, 2022, 37(11): 3713-3719.
14. Helmers MR, Fowler C, Kim ST, et al. Repair of isolated native mitral valve endocarditis: a propensity matched study. Semin Thorac Cardiovasc Surg, 2022, 34(2): 490-499.
15. Oliver L, Leauthier M, Jamme M, et al. Mitral valve repair is better than mitral valve replacement in native mitral valve endocarditis: results from a prospective matched cohort. Arch Cardiovasc Dis, 2022, 115(3): 160-168.
16. Moore RA, Witten JC, Lowry AM, et al. Isolated mitral valve endocarditis: patient, disease, and surgical factors that influence outcomes. J Thorac Cardiovasc Surg, 2024, 167(1): 127-140.e15.
17. Roberts WC, Salam YM, Roberts CS. Morphologic findings in native mitral valves replaced for isolated acute infective endocarditis. Am J Cardiol, 2022, 162: 136-142.
18. Solari S, Navarra E, de Kerchove L, et al. Mitral valve repair for endocarditis. J Card Surg, 2022, 37(12): 4097-4102.
19. Defauw RJ, Tomšič A, van Brakel TJ, et al. A structured approach to native mitral valve infective endocarditis: is repair better than replacement? Eur J Cardiothorac Surg, 2020, 58(3): 544-550.
20. Scheggi V, Olivotto I, Del Pace S, et al. Feasibility and outcome of mitral valve repair in patients with infective endocarditis. Cardiothorac Surg, 2020, 28(1): 1-10.
21. Miura T, Obase K, Ariyoshi T, et al. Impact of lesion localization on durability of mitral valve repair in infective endocarditis. Ann Thorac Surg, 2020, 109(5): 1335-1342.
22. Tepsuwan T, Rimsukcharoenchai C, Tantraworasin A, et al. Comparison between mitral valve repair and replacement in active infective endocarditis. Gen Thorac Cardiovasc Surg, 2019, 67(12): 1030-1037.
23. Solari S, De Kerchove L, Tamer S, et al. Active infective mitral valve endocarditis: is a repair-oriented surgery safe and durable? Eur J Cardiothorac Surg, 2019, 55(2): 256-262.
24. Cuerpo GP, Valerio M, Pedraz A, et al. Mitral valve repair in infective endocarditis is not inferior to valve replacement: results from a Spanish Nationwide Prospective Registry. Gen Thorac Cardiovasc Surg, 2019, 67(7): 585-593.
25. El Gabry M, Haidari Z, Mourad F, et al. Outcomes of mitral valve repair in acute native mitral valve infective endocarditis. Interact Cardiovasc Thorac Surg, 2019, 29(6): 823-829.
26. Lee HA, Lin CY, Chen YC, et al. Surgical interventions of isolated active mitral valve endocarditis: predisposing factors and impact of neurological insults on final outcome. Medicine (Baltimore), 2018, 97(11): e0054.
27. 白贵学. 二尖瓣成形术在感染性心内膜炎二尖瓣关闭不全治疗中的价值探析. 养生保健指南, 2018, 19: 20-21.Bai GX. Value analysis of mitral valvuloplasty in the treatment of mitral regurgitation caused by infective endocarditis. Health Guide, 2018, 19: 20-21.
28. Tomšic A, Versteegh MIM, Ajmone Marsan N, et al. Early and late results of surgical treatment for isolated active native mitral valve infective endocarditis. Interact Cardiovasc Thorac Surg, 2018, 26(4): 610-616.
29. Perrotta S, Fröjd V, Lepore V, et al. Surgical treatment for isolated mitral valve endocarditis: a 16-year single-centre experience. Eur J Cardiothorac Surg, 2018, 53(3): 576-581.
30. Habib G, Hoen B, Tornos P, et al. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Eur Heart J, 2009, 30(19): 2369-2413.
31. Hu YN, Wan S. Repair of infected mitral valves: what have we learned? Surg Today, 2018, 48(10): 899-908.
32. Siquier-Padilla J, Cuervo G, Urra X, et al. Optimal timing for cardiac surgery in infective endocarditis with neurological complications: a narrative review. J Clin Med, 2022, 11(18): 5275.
33. Murai R, Funakoshi S, Kaji S, et al. Outcomes of early surgery for infective endocarditis with moderate cerebral complications. J Thorac Cardiovasc Surg, 2017, 153(4): 831-840.
34. Samura T, Yoshioka D, Toda K, et al. Emergency valve surgery improves clinical results in patients with infective endocarditis complicated with acute cerebral infarction: analysis using propensity score matching. Eur J Cardiothorac Surg, 2019, 56(5): 942-949.
35. Ruttmann E, Abfalterer H, Wagner J, et al. Endocarditis-related stroke is not a contraindication for early cardiac surgery: an investigation among 440 patients with left-sided endocarditis. Eur J Cardiothorac Surg, 2020, 58(6): 1161-1167.
36. Musleh R, Schlattmann P, Caldonazo T, et al. Surgical timing in patients with infective endocarditis and with intracranial hemorrhage: a systematic review and meta-analysis. J Am Heart Assoc, 2022, 11(10): e024401.
37. Yaftian N, Buratto E, Ye XT, et al. Long-term outcomes of mitral valve endocarditis: improved survival through collaborative management. ANZ J Surg, 2020, 90(5): 757-761.
38. 陈金淼, 何晨, 王春生, 等. 二尖瓣成形术治疗感染性心内膜炎(IE)的中长期疗效. 复旦学报(医学版), 2015, 42(1): 105-107, 118.Chen JM, He CM, Wang CS, et al. Mid-long term outcomes of mitral valve reconstruction for infective endocarditis (IE). Fudan Univ J Med Sci, 2015, 42(1): 105-107, 118.
39. Pektok E, Sierra J, Cikirikcioglu M, et al. Midterm results of valve repair with a biodegradable annuloplasty ring for acute endocarditis. Ann Thorac Surg, 2010, 89(4): 1180-1185.
40. Musci M, Hübler M, Amiri A, et al. Repair for active infective atrioventricular valve endocarditis: 23-year single center experience. Clin Res Cardiol, 2011, 100(11): 993-1002.
41. Rostagno C, Carone E, Stefàno PL. Role of mitral valve repair in active infective endocarditis: long term results. J Cardiothorac Surg, 2017, 12(1): 29.
42. Kanemitsu H, Nakamura K, Fukunaga N, et al. Long-term outcomes of mitral valve repair for active endocarditis. Circ J, 2016, 80(5): 1148-1152.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Latest ArticlesResearch progress of mitral valvuloplasty in patients with infective endocarditis

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