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Abstract：
BACKGROUND: The benefits of mitral repair versus replacement for endocarditis are inconclusive. This study compares outcomes of patients with infective endocarditis undergoing mitral valve repair versus replacement and investigates the impact of microbial etiology.
METHODS: All 251 patients undergoing mitral valve surgery for active endocarditis between 2010 and 2023 were enrolled, 180 (71.7%) replacement and 71 (28.3%) repair. To adjust for imbalances, inverse probability of treatment weighting was applied and 187 patients were obtained.
RESULTS: The analysis between groups, following the application of inverse probability of treatment weighting, showed no statistically significant differences across all considered outcomes. Early and late death was observed respectively in 6 (8.5%) and 11 (15.5%) patients in the repair group versus 24 (13.3%) and 45 (25.0%) in the replacement group without statistical significance (p = 0.221 and p = 0.446). Relapse occurred in six patients (8.5%) in the repair group after a median time of 4.0 months and in six (3.3%) in the replacement after 6.9 months (p = 0.071).
CONCLUSIONS: Surgical strategy in mitral endocarditis has no effect on major postoperative complications, mortality, or medium/long-term survival. Staphylococcus aureus and Coagulase-negative Staphylococci represent a risk for early mortality and relapse. However, mitral valve repair for endocarditis can be pursued when it ensures the complete eradication of all infected tissue, particularly in cases caused by Streptococcus infection, in young patients, and after a minimum of 18 days of antibiotic therapy.
METHODS: All 251 patients undergoing mitral valve surgery for active endocarditis between 2010 and 2023 were enrolled, 180 (71.7%) replacement and 71 (28.3%) repair. To adjust for imbalances, inverse probability of treatment weighting was applied and 187 patients were obtained.
RESULTS: The analysis between groups, following the application of inverse probability of treatment weighting, showed no statistically significant differences across all considered outcomes. Early and late death was observed respectively in 6 (8.5%) and 11 (15.5%) patients in the repair group versus 24 (13.3%) and 45 (25.0%) in the replacement group without statistical significance (p = 0.221 and p = 0.446). Relapse occurred in six patients (8.5%) in the repair group after a median time of 4.0 months and in six (3.3%) in the replacement after 6.9 months (p = 0.071).
CONCLUSIONS: Surgical strategy in mitral endocarditis has no effect on major postoperative complications, mortality, or medium/long-term survival. Staphylococcus aureus and Coagulase-negative Staphylococci represent a risk for early mortality and relapse. However, mitral valve repair for endocarditis can be pursued when it ensures the complete eradication of all infected tissue, particularly in cases caused by Streptococcus infection, in young patients, and after a minimum of 18 days of antibiotic therapy.
摘要：
背景：二尖瓣修复与置换治疗心内膜炎的益处尚无定论。这项研究比较了感染性心内膜炎患者接受二尖瓣修复与置换的结果，并调查了微生物病因的影响。
方法：纳入2010年至2023年因活动性心内膜炎而接受二尖瓣手术的251例患者，180（71.7％）更换和71（28.3％）维修。为了适应失衡，应用治疗加权的逆概率,获得187名患者。
结果：组间分析，在应用逆概率治疗加权后，在所有考虑的结果中没有显示出统计学上的显著差异。修复组分别有6例(8.5%)和11例(15.5%)患者早期死亡和晚期死亡，置换组24例(13.3%)和45例(25.0%)患者早期死亡和晚期死亡，无统计学意义(p=0.221和p=0.446)。修复组的6名患者（8.5％）在中位时间为4.0个月后复发，置换组的6名患者（3.3％）在6.9个月后复发（p=0.071）。
结论：二尖瓣心内膜炎的手术策略对术后主要并发症没有影响，死亡率,或中期/长期生存。金黄色葡萄球菌和凝固酶阴性葡萄球菌代表早期死亡和复发的风险。然而,当确保完全根除所有感染组织时，可以进行心内膜炎的二尖瓣修复，特别是在由链球菌感染引起的病例中，在年轻患者中，并在至少18天的抗生素治疗后。
方法：纳入2010年至2023年因活动性心内膜炎而接受二尖瓣手术的251例患者，180（71.7％）更换和71（28.3％）维修。为了适应失衡，应用治疗加权的逆概率,获得187名患者。
结果：组间分析，在应用逆概率治疗加权后，在所有考虑的结果中没有显示出统计学上的显著差异。修复组分别有6例(8.5%)和11例(15.5%)患者早期死亡和晚期死亡，置换组24例(13.3%)和45例(25.0%)患者早期死亡和晚期死亡，无统计学意义(p=0.221和p=0.446)。修复组的6名患者（8.5％）在中位时间为4.0个月后复发，置换组的6名患者（3.3％）在6.9个月后复发（p=0.071）。
结论：二尖瓣心内膜炎的手术策略对术后主要并发症没有影响，死亡率,或中期/长期生存。金黄色葡萄球菌和凝固酶阴性葡萄球菌代表早期死亡和复发的风险。然而,当确保完全根除所有感染组织时，可以进行心内膜炎的二尖瓣修复，特别是在由链球菌感染引起的病例中，在年轻患者中，并在至少18天的抗生素治疗后。
