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Contemporary trends and outcomes of mitral valve surgery for infective endocarditis
Author(s) -
Alkhouli Mohamad,
Alqahtani Fahad,
Berzingi Chalak,
Cook Chris C.
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14116
Subject(s) - medicine , infective endocarditis , propensity score matching , dialysis , concomitant , surgery , endocarditis , stroke (engine) , mitral valve replacement , mitral valve , cardiac surgery , cardiology , aortic valve replacement , incidence (geometry) , mitral valve repair , mechanical engineering , physics , optics , stenosis , engineering
Background Contemporary data on mitral valve (MV) surgery in patients with infective endocarditis (IE) are limited. Methods The National Inpatient Sample was queried to identify patients with IE who underwent MV surgery between 2003 and 2016. We assessed (a) temporal trends in the incidence of MV surgery for IE, (b) morbidity, mortality, and cost of MV repair vs replacement, and (c) predictors of in‐hospital mortality. Results The proportion of MV operations involving patients with IE increased from 5.4% in 2003 to 7.3%, and the proportion of MV repair among those undergoing surgery for IE increased from 15.2% to 25.0% ( P trend < .001). In‐hospital mortality was higher in the replacement group (11.3% vs 8.1%; P < .001), and this excess mortality persisted after propensity score matching (11.2% vs 8.1%; P < .001), and in sensitivity analyses excluding concomitant surgery (unadjusted 11.3% vs 4.8%; adjusted 8.5% vs 4.5%; P < .001), and stratifying patients by the time of operation (within 7 days, 11.3% vs 6.8%; P < .001 and >7 days, 11.9% vs 9.1%; P = .012). In the propensity‐matched cohorts, shock and need for tracheostomy were more frequent in the replacement group, but rates of stroke, pacemaker implantation, new dialysis, and blood transfusion were similar. Mitral valve repair was, however, associated with shorter hospitalizations, more home discharges, and less cost. In a multivariate regression analysis, age above 70 and chronic dialysis were the strongest predictors of in‐hospital mortality. Conclusion Mitral valve repair in IE patients is associated with lower in‐hospital mortality, resource utilization, and cost compared with MV replacement.