Evaluation of Tricuspid Valve Repair Without Annuloplasty Ring in Intravenous Drug Abusers

Abstract

Background: Tricuspid valve endocarditis among intravenous (IV) drug abusers is increasing in prevalence in modern societies. The increased risk of reinfection in such patients makes surgical reintervention a risky decision. Repair is preferred over replacement to minimize the presence of foreign material in a potentially infected field.

Methods: A retrospective, observational, comparative, nonrandomized study included all living patients presenting with isolated tricuspid valve endocarditis due to IV drug abuse who had undergone tricuspid valve repair or replacement. Of 223 patients who were operated on between January 2014 and January 2016, 128 underwent tricuspid valve replacement (replacement group), and 95 underwent tricuspid valve repair (repair group).

Results: Before hospital discharge, 87 patients of the repair group had mild tricuspid regurgitation (TR), and 8 had moderate TR by transthoracic echocardiography. The 6-month follow-up showed that 86 patients still had mild TR, 7 had moderate TR, and only 1 progressed to severe TR. After 1 year, 84 patients still had mild TR, 6 had moderate TR, and 4 had severe TR. At the 2-year follow-up, 78 patients still had mild TR, 11 had moderate TR, and only 5 had severe TR.

Conclusions: Valve repair can be considered a proper surgical plan in isolated endocarditis among IV drug abusers with results comparable to a replacement and ensuring the minimal use of foreign material in such patients.