Long-term outcome of extensive mitral valve reconstruction with
autologous pericardium and artificial chordae for treatment of
destructive active infective endocarditis of the mitral valve
Background and aim: Mitral valve (MV) repair is a well-accepted surgical
approach for infective endocarditis (IE). In our hospital, extensive MV
reconstruction with fresh autologous pericardium (AP) and artificial
chordae (AC) has been performed for patients with profoundly extensive
and destructive IE in which valve reconstruction would be extremely
challenging, especially in young patients to avoid mechanical valve
replacement. Long-term outcome including the future performance of the
newly created leaflet has not been established. Methods: Five patients
(50 ± 30 years of age; 3 men, 2 women) underwent this procedure from
January 2011 to December 2020. In all patients, preoperative cardiac
function was good (left ventricular ejection fraction, 70% ± 5%).
After complete debridement of the infective valve tissue, the MV was
reconstructed with large, fresh, trimmed AP and AC. Results: The
reconstructed leaflets were anterior in three patients and posterior in
four, and AC were placed in four patients. All patients showed an
uneventful postoperative course and were discharged to home 35 ± 5 days
postoperatively after completion of intravenous antibiotic therapy.
Pre-discharge echocardiography revealed no or trivial mitral
regurgitation (MR) in all patients. The mean follow-up period was 7.2
(range, 1.3–9.5) years, and no patients developed recurrence of the IE.
The latest echocardiography in four patients showed trivial/mild MR with
good leaflet function. One patient developed recurrence of MR, 5 months
postoperatively. Conclusions: The short- and long-term outcomes of this
procedure were satisfactory. This procedure might be considered as an
effective and valuable option, especially in young patients.