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

Abstract

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

Methods: Institutional Society of Thoracic Surgeons (STS) Adult Cardiac Surgery Database evaluated all patients undergoing valve surgery for endocarditis (1/2016-3/2024). Patients were stratified by conventional sternotomy vs MICS approach, including hemi-sternotomy, right -thoracotomy, and robotic-assisted mitral/tricuspid/aortic valve surgery. Logistic regression assessed risk-adjusted association with the primary outcomes of STS major morbidity or mortality and MICS approach accounting for all covariates in current STS risk models.

Results: Of 741 patients undergoing valve surgery for endocarditis, median age 37 years, 582 (78.5%) had substance use disorder, 210 (28.3%) redo sternotomies and 166 (22.4%) redo valve operations. MICS was associated with a higher repair rate for mitral valves (76.3% vs 48%, p<0.0001) but lower for tricuspid valve (22.5% vs 44.1%, p<0.0001), with no difference for aortic valves (8.3% vs 7.4%, p=0.372). Prior to risk adjustment, MICS was associated with longer cross clamp times (99 min vs 86 min, p=0.019) but lower incidence of STS major morbidity or mortality (15.4% vs 27.8%, p=0.019). After robust risk adjustment, age (OR 1.1, p=0.008), lung disease (OR 2.2, p=0.010), preoperative creatinine (OR 1.3, p=0.016), 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 surgery for endocarditis appears both safe and effective, with similar repair rates and risk adjusted outcomes to open surgery.