{"id":"46085","type":"article","url":"https://hartvaat.nl/2026/04/15/mitralisklepreparatie-bij-endocarditis-geeft-betere-langetermijnoverleving-dan-k/","title":"Mitralisklepreparatie bij endocarditis geeft betere langetermijnoverleving dan klepvervanging","title_en":"","category":"algemeen","category_label":"Algemeen","professions":["cardioloog"],"tags":[],"journal":"Open Heart","doi":"http://openheart.bmj.com/cgi/content/short/13/1/e004008?rss=1","source_url":"https://doi.org/http://openheart.bmj.com/cgi/content/short/13/1/e004008?rss=1","authors":["Momin","A.","Ranjan","R.","Sowden","W.","Sarsam","M.","Chandrasekaran","V."],"significance":5,"published":"2026-07-23","source_date":"2026-04-15","image":"","kennis":["https://hartvaat.nl/kennis/kleplijden/mitraclip-transcatheter-mitralisreparatie/","https://hartvaat.nl/kennis/farmacologie/betablokkers-cardiale-indicaties/"],"congress":"","summary_en":"The optimal surgical strategy for mitral valve (MV) endocarditis is uncertain: although repair is increasingly advocated, replacement is often performed, and good comparative long-term data are lacking. In this retrospective single-centre study (88 consecutive patients undergoing MV surgery for endocarditis-related mitral regurgitation, 2011-2025), replacement was performed in 51%; these patients were older (median 62 vs 51 years). In-hospital mortality was 4.5% (no deaths in the repair group) and long-term mortality 14.8%. In the replacement group, older age and diabetes (OR 7.8) independently predicted mortality. Mean survival was significantly longer after repair than replacement (161 vs 130 months). MV repair for endocarditis is thus safe and associated with better long-term survival; diabetes is a strong risk factor in replacement.","created":"2026-07-03T20:27:17Z","updated":"2026-07-04T19:09:44Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"De optimale chirurgische strategie bij mitralisklep(MV)-endocarditis is onzeker: hoewel reparatie steeds vaker wordt bepleit, wordt vaak vervangen, en goede vergelijkende langetermijndata ontbreken. In deze retrospectieve single-centerstudie (88 opeenvolgende patiënten met MV-chirurgie wegens endocarditis-gerelateerde mitralisinsufficiëntie, 2011-2025) werd bij 51% een klepvervanging gedaan; deze patiënten waren ouder (mediaan 62 vs. 51 jaar). De ziekenhuissterfte was 4,5% (geen sterfgevallen in de reparatiegroep) en de langetermijnsterfte 14,8%. In de vervangingsgroep voorspelden hogere leeftijd en diabetes (OR 7,8) onafhankelijk de sterfte. De gemiddelde overleving was significant langer na reparatie dan na vervanging (161 vs. 130 maanden). Mitralisklepreparatie bij endocarditis is dus veilig en gaat gepaard met een betere langetermijnoverleving; diabetes is een sterke risicofactor bij vervanging.","abstract_original":"<sec><st>Background</st>\n<p>The optimal surgical strategy for mitral valve (MV) infective endocarditis (IE) remains uncertain. Although valve repair is increasingly advocated, MV replacement is frequently performed, and robust data comparing long-term outcomes between approaches are limited. We evaluated long-term survival following MV repair vs replacement in patients with IE-related mitral regurgitation.</p>\n</sec>\n<sec><st>Methods</st>\n<p>We retrospectively analysed 88 consecutive patients who underwent MV surgery for IE-associated mitral regurgitation at St George&rsquo;s Hospital NHS Foundation Trust, UK, between June 2011 and May 2025. Long-term all-cause mortality was assessed using Kaplan-Meier survival analysis. Multivariable logistic regression identified independent predictors of mortality, and model discrimination was evaluated using the area under the receiver operating characteristic (AUROC) curve.</p>\n</sec>\n<sec><st>Results</st>\n<p>The cohort comprised 65% men with a median age of 57 years (IQR 44.0&ndash;64.8). MV replacement was performed in 51.1% of patients who were older than those undergoing repair (median age 62 vs 51 years). In-hospital mortality was 4.5% and long-term all-cause mortality was 14.8%. No in-hospital deaths occurred in the repair group. In age-adjusted and sex-adjusted analyses among replacement patients, increasing age (OR 1.1; 95% CI 1.0 to 1.1; p=0.03) and diabetes mellitus (OR 7.8; 95% CI 1.3 to 48.8; p=0.02) independently predicted long-term mortality. The model demonstrated good discrimination (AUROC 0.83; 95% CI 0.69 to 0.97). Mean survival was significantly longer following repair than replacement (161.0 vs 129.9 months; p=0.008).</p>\n</sec>\n<sec><st>Conclusions</st>\n<p>MV repair for infective endocarditis is safe and associated with superior long-term survival compared with replacement. Diabetes mellitus is a strong independent predictor of mortality in the MV replacement group, highlighting the importance of risk stratification in surgical decision-making.</p>\n</sec>"}