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Rostagno. Vessel Plus 2020;4:7 Vessel Plus
DOI: 10.20517/2574-1209.2019.29

Review Open Access

Mitral valve repair in infective endocarditis: which
evidence?

Carlo Rostagno
Dipartimento medicina sperimentale e clinica, Università di Firenze, Firenze 50124, Italy.

Correspondence to: Prof. Carlo Rostagno, Dipartimento Medicina Sperimentale e Clinica, Università di Firenze - Viale Morgagni
85, Firenze 50124, Italy. E-mail: carlo.rostagno@unifi.it

How to cite this article: Rostagno C. Mitral valve repair in infective endocarditis: which evidence? Vessel Plus 2020;4:7.
http://dx.doi.org/10.20517/2574-1209.2019.29

Received: 23 Nov 2019 First Decision: 10 Jan 2020 Revised: 12 Mar 2020 Accepted: 17 Mar 2020 Published: 10 Apr 2020
Science Editor: Mario F. L. Gaudino Copy Editor: Jing-Wen Zhang Production Editor: Tian Zhang

Abstract
Infective endocarditis is still a challenging clinical condition undergoing continuous epidemiologic changes, involving
both the population at risk and the microbiological etiology. Antibiotic treatment alone is not effective in presence of
structural abnormalities of native valves, leading to heart failure and/or to high embolic risk. Moreover, some patients
despite being treated with antibiotics, their valve leaflets may undergo profound degenerative changes responsible for
significant hemodynamic abnormalities. The resulting valve disease may lead to a decreased life expectancy. In these
patients, surgery was the only independent factor associated with long-term survival. Valve repair in the last two decades
has demonstrated to be a valuable alternative to valve replacement in mitral valve 0 endocarditis. Mitral valve repair was
associated with decreased hospital and long-term mortality, recurrent endocarditis and overall need for reoperation in
comparison to valve replacement. Furthermore, repair limits the risks related to prolonged anticoagulation. However,
these results suffer from several limitations: results of repair are dependent on the experience of surgical team, valve
damage is usually less extended in patients undergoing repair as well clinical and hemodynamic impairment are more
severe in patients undergoing replacement. Therefore, although repair should be preferred when technically feasible
caution must be paid to assess its absolute superiority in comparison to valve replacement.

Keywords: Infective endocarditis, valve repair, valve replacement, survival

INTRODUCTION

Epidemiology of native valve endocarditis
The epidemiology of native valve endocarditis has undergone significant changes over the past few decades.
The incidence is reported between 1.5 and 5 per 100,000 persons per year, although large epidemiological

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