Minimally Invasive Valve Surgery for Patients With Infective Endocarditis: A Comparative Study

Abstract

Background

Patients with endocarditis frequently require valve surgical procedure, and despite the recent growth of minimally invasive cardiac surgery (MICS) for complex valve operations, consensus recommendations still suggest conventional sternotomy.

Methods

The institutional Adult Cardiac Surgery Database of The Society of Thoracic Surgeons (STS) evaluated all patients undergoing valve surgical procedure for endocarditis from July 2016 to March 2024. Patients were stratified by conventional sternotomy vs an MICS approach, including hemisternotomy, right thoracotomy, and robotic-assisted mitral, tricuspid, or aortic valve surgical procedure. Logistic regression assessed the risk-adjusted association with the primary outcomes of STS major morbidity or mortality and the MICS approach by accounting for all covariates in current STS risk models.

Results

Of 741 patients undergoing valve surgical procedure for endocarditis, the median age was 37 years, 582 (78.5%) had a substance use disorder, 210 (28.3%) underwent redo sternotomies, and 166 (22.4%) had redo valve operations. MICS was associated with a higher repair rate for mitral valves (76.3% vs 48%; P < .0001) but a lower rate for tricuspid valve (22.5% vs 44.1%; P < .0001), with no difference for aortic valves (8.3% vs 7.4%; P = .372). Before risk adjustment, MICS was associated with longer cross-clamp times (99 minutes vs 86 minutes; P = 0.019) but a lower incidence of STS major morbidity or mortality (15.4% vs 27.8%; P = 0.019). After robust risk adjustment, age (odds ratio [OR], 1.1; P = 0.008), lung disease (OR, 2.2; P = 0.010), preoperative creatinine (OR, 1.3; P = 0.016), and valve repair vs replacement (OR, 0.17; P = 0.002), but not MICS (OR, 1.2; P = 0.807), were independently associated with STS major morbidity and mortality.

Conclusions

MICS valve surgical procedure for endocarditis appears both safe and effective, with repair rates and risk-adjusted outcomes similar to those of open surgical procedure.