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Rostagno. Vessel Plus 2020;4:7 I http://dx.doi.org/10.20517/2574-1209.2019.29 Page 5 of 7

for concomitant surgical procedures (CABG, aortic replacement, tricuspid repair/replacement), although
[25]
MV replacement was sometimes preferred in these patients . It must be emphasized that patients who
underwent MV replacement were on average older with more preoperative comorbidities and severe
[22]
clinical conditions .
CONCLUSION
Results from previous investigations [Table 3] suggest that MV repair in native MV endocarditis is
associated with a significant decrease in early and long-mortality, endocarditis recurrence and need for re-
intervention. In particular, the risk of reinfection is significantly higher (from 8% to 27% vs. less than 3%) in
patients with MV replacement. The number of patients undergoing repair is still highly variable in different
centers (from 18% to 80%). Experience of surgical team in repair techniques is essential particularly when
facing extensive damage of MV components. Low-volume centers show significantly lower repair rates
with suboptimal results and higher re-intervention rate. Several limitations should be considered in the
evaluation of studies reporting favorable results of MV repair in infective endocarditis.

Firstly, all published investigations are retrospective observational studies and no randomized control study
has ever done comparing the two techniques. Considering present evidence, it appears difficult that it will
ever be proposed in the future. Nevertheless, a selection bias may affect most of reported experience since
valve replacement was mainly performed in patients with more severe clinical conditions and extensive
valve damage. This may have contributed both to higher hospital and long-term mortality reported in
valve replacement group. Concomitant surgical procedures were performed more frequently in patients
undergoing valve replacement than in patients with MV repair, carrying a higher surgical risk.

Thirdly in the everyday life, management of MV endocarditis depends on experience of surgical teams.
This appears the main determinant in the strategy adopted for surgery and its outcomes. A lower repair
rates and less optimal outcomes, with residual valve regurgitation and need for re-intervention, has been
reported in low-volume centers.

Finally, microbiological etiology may play a relevant role in establish surgical strategy. Staphylococcus
aureus related IE are associated with more extensive valve lesions and significantly higher mortality. A
lower repair rate, although not uniformly reported in different centers, is often observed in patients with
staphylococcus infection.

In conclusion, MV repair may be considered the first choice treatment of MV endocarditis “with favorable
anatomy” in experienced centers. However, multidisciplinary evaluation should direct definite choice in the
individual patient.

DECLARATIONS
Authors’ contributions
The author contributed solely to the article.

Availability of data and materials
Not applicable.

Financial support and sponsorship
None.

Conflicts of interest
The author declared that there are no conflicts of interest.