Valve repair is better than valve replacement in patients operated on for native mitral valve endocarditis

Background and Objectives In native mitral valve infective endocarditis (NMVIE), the respective values of mitral valve repair (MVR) and mitral valve replacement (MVRP) are still debated. We compared MVR and MVRP in a large prospective series of pts operated on for NMVIE in La Timone Hospital, Marseille. Methods Between 2010 and 2017, 151 pts with NMVIE underwent early ( Results As compared with MVR, MVRP pts had more associated aortic abscess (15 vs 4%, P  = 0.03), and more restrictive lesions (28 vs 3%, P P  = 0.002), cerebral embolism ( P P P  = 0.001), while MVR was protective ( P  = 0.001). By multivariate analysis, factors associated with bad outcome were cerebral embolism (HR = 3.46, P P  = 0.04), while only MVR was protective (HR = 0.36, P  = 0.003). Death occurred in-hospital in 8 (5%) pts and during the 6-month FU in 16 (11%) pts. MVR was associated with lower in-hospital and long-term mortality (HR = 0.11, CI 0.02–0.45, P  = 0.002, and HR = 0.22, CI 0.08–0.58, P  = 0.002, respectively). Timing of surgery had no influence on prognosis, while commissural lesions were paradoxically associated with better outcome ( P  = 0.02). Conclusion Early MVR for NMVIE is associated with better outcome than MVRP, without excess reoperation rate, residual mitral regurgitation, or recurrence. In experienced hands, early MVR is technically feasible in 76% of NMVIE and should be the preferred option in these pts.