Contemporary trends and outcomes of mitral valve surgery for infective endocarditis.
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% (Ptrend  < .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.
['Alkhouli|Mohamad|M|http://orcid.org/0000-0003-3847-0959', 'Alqahtani|Fahad|F|', 'Berzingi|Chalak|C|', 'Cook|Chris C|CC|']
D000367:Age Factors D000368:Aged D015331:Cohort Studies D003365:Costs and Cost Analysis D015314:Dialysis Solutions D004696:Endocarditis D005260:Female D019918:Heart Valve Prosthesis Implantation D017052:Hospital Mortality D006801:Humans D007902:Length of Stay D008297:Male D008875:Middle Aged D008943:Mitral Valve D058386:Mitral Valve Annuloplasty D012044:Regression Analysis D016896:Treatment Outcome
infective endocarditis mitral valve repair mitral valve replacement