Mitral Valve Replacement Associated with Increased Endocarditis Risk

A recent study published in the *European Heart Journal* has revealed significant findings regarding the risks associated with mitral valve replacement (MVR) compared to mitral valve repair (MVR). Conducted by Dr. Amna Alhakak of Copenhagen University Hospital Rigshospitalet, the research indicates that patients who underwent MVR exhibited a more than threefold increase in the 10-year incidence of infective endocarditis compared to those classified at moderate risk for the disease.

The study analyzed data from Danish registries, tracking 1,220 adults who underwent first-time MVR and 3,239 who underwent mitral valve repair between 2000 and 2020. The median age of the MVR group was 67, with 52.1% being men, while the repair group had a median age of 66, with 72.0% men. The researchers defined incident infective endocarditis based on hospitalization criteria, comparing outcomes with a control group of 209,517 patients at moderate risk for the disease, which included individuals with cardiac implantable electronic devices, congenital heart valve anomalies, hypertrophic cardiomyopathy, rheumatic heart disease, and nonrheumatic degenerative valve disease.

The findings were stark: over a decade, 6.1% of patients who underwent MVR were diagnosed with infective endocarditis, compared to only 1.6% of those who underwent repair and 1.7% of those at moderate risk. The adjusted hazard ratio for developing infective endocarditis after MVR was 3.52, indicating a significant risk differential compared to the moderate-risk group. Notably, the study also highlighted that the 10-year rate of the condition was about 66-fold higher among MVR patients when compared to matched control individuals.

Dr. Giacoppo from the University of Catania noted the importance of these findings for clinical practice, suggesting that future research could clarify the need for antibiotic prophylaxis in patients undergoing both MVR and repair. This study underscores the necessity of developing preventive strategies and surveillance protocols for patients with prosthetic mitral valves.

Despite these significant findings, the study does have limitations, including its observational nature and the potential for confounding factors. Specifically, the study could not assert causation between mitral valve interventions and the occurrence of infective endocarditis. Furthermore, microbiological data were not consistently available throughout the follow-up period.

This research, funded by the Research Fund of Rigshospitalet, contributes to the ongoing discourse regarding the management of patients undergoing mitral valve interventions. As healthcare continues to evolve, understanding the risks associated with surgical options remains paramount for improving patient outcomes and informing clinical guidelines. The implications of this study could influence future recommendations regarding antibiotic prophylaxis and patient monitoring strategies, ultimately enhancing the standard of care for individuals with mitral valve defects.

The study highlights the critical need for ongoing surveillance and research to better understand the relationship between mitral valve procedures and infective endocarditis, aiming to improve patient safety and treatment outcomes in cardiovascular care.

For more information, refer to the original study published by Dr. Amna Alhakak and colleagues in the *European Heart Journal* on July 11, 2025.