Mitral valve repair versus replacement for endocarditis: A propensity-score matched analysis of early postoperative outcomes

Objective
We sought to compare early postoperative outcomes between mitral valve repair (MVr) and replacement (MVR) in patients with mitral valve endocarditis.

Background
The optimal surgical approach for mitral valve endocarditis remains controversial, with some studies suggesting that mitral valve repair may be associated with better outcomes than mitral valve replacement and others suggesting no significant differences. This study compares the early postoperative outcomes between repair and replacement in this cohort using a large national database.

Methods
A retrospective, propensity-score matched analysis was conducted using the national data from the United Kingdom, comparing 1381 patients who underwent repair and 3276 patients who underwent replacement between 2000 and 2019. The primary outcome was in-hospital mortality, and secondary outcomes included prolonged admission (>10 days), re-exploration for bleeding, postoperative stroke, and postoperative dialysis. Binary logistic regression models were conducted in the matched group to further examine the relationship between procedure and outcomes.

Results
After propensity-score matching, 1249 pairs were identified. In-hospital mortality was significantly lower in the repair group (4% vs 7%, p < .001). Rates of re-exploration for bleeding (6% vs 9%, p = .019), postoperative stroke (1% vs 3%, p = .030), and postoperative dialysis (5% vs 7%, p = .016) were also significantly lower in the repair group. Binary logistic regression analyses demonstrated repair to be independently associated with lower risk of both mortality (OR:0.65, 95% CI:0.43-0.97, p = .034) and re-exploration for bleeding (OR:0.70, 95% CI:0.51-0.96, p < .028).

Conclusions
This study suggests that patients receiving repair for mitral valve endocarditis have significantly lower mortality and better early postoperative outcomes than those receiving replacement.