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Objectives: Mitral repair in active infective endocarditis still remains controversial. Several studies demonstrate the feasibility of mitral repair in infective endocarditis; however, superiority of repair has never been shown. The aim of the investigation was to compare valve repair and valve replacement in respect to the extent of destruction and to analyze survival, recurrent endocarditis, and reoperation (event-free survival). Methods: Sixty-eight consecutive patients underwent surgical intervention for mitral endocarditis. Thirty-four (50%) patients had valve repair, and 34 (50%) patients had valve replacement. Leaflet destruction involving at least one mitral leaflet was present in 15 (44.1%) patients of the repair group and 11 (32.4%) patients of the replacement group. Repair of the mitral annulus with pericardium was performed in 4 (11.8%) patients in the repair group and 3 (8.8%) patients in the replacement group. Patients in both groups were similar concerning the progression of valvular destructions and comorbidities. Results: Hospital mortality was 11.8% (8 patients). No significant differences were found in all baseline parameters, with the exception of a higher incidence of previous septic embolism and sepsis in the repair group. Actuarial event-free survival at 1 year was 88.2% in the repair group compared with 67.7% in the replacement group, and 5-year event-free survival was 80.4% in the repair group and 54.6% in the replacement group (P = .015). Mitral valve repair remained the superior treatment regarding event-free survival in the multivariate analysis (hazard ratio, 0.33; 95% confidence interval, 0.12-0.93; P = .02). Conclusions: Mitral valve repair offers excellent early and late results and is the preferable treatment option in the surgical therapy of native infective endocarditis. [Copyright &y& Elsevier]

Background: Lung transplantation has become important in treating end-stage lung disease; however, bronchial complications are common. Lack of bronchial arterial circulation, ischemic time, and acute rejection episodes may damage the bronchial wall. In this study, we analyzed factors that may hamper bronchial airway healing, requiring intervention after lung transplantation.Methods: We collected data from a consecutive series of 81 transplantations performed between 1993 and 2002 and evaluated recipients for bronchial complications. In 30 single and 51 sequential bilateral lung transplantations, a total of 132 anastomoses were performed. Four patients (3 bilateral and 1 single lung transplant recipients who died within the first 14 post-operative days were excluded from the analysis. Finally, 125 lung grafts remained for statistical analysis of factors influencing bronchial complications.Results: Peri-operative mortality was 8.9%. Eleven patients (14.7%) experienced severe bronchial complications in 16 of 125 evaluated bronchial anastomoses (12.8%) and required surgical treatment or bronchoscopic interventional therapy. In a multivariate logistic regression model, severe reperfusion edema (adjusted odds ratio, 8.3; p = 0.002) and rejection episode within the 1st post-operative month (adjusted odds ratio, 4.1; p = 0.036) were associated with bronchial complications. Using the univariate model, we found that factors such as interleukin-2-antibody induction therapy, immunosuppression, or bronchial anastomotic technique had significant influence on bronchial healing, whereas we could not confirm this when using multivariate anasysis.Conclusions: Preventing reperfusion edema with optimized lung preservation and with early and aggressive medical treatment or mechanical hemodynamical support (e.g., veno-arterial extra corporal membrane oxygenation are necessary to avoid prolonged ventilation dependence, which may result in bronchial complications. Furthermore, avoiding early rejection episodes promotes uncomplicated bronchial healing. [Copyright &y& Elsevier]