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. 2022 Apr;13(2):110-117.
doi: 10.14740/cr1359. Epub 2022 Mar 12.

Isolated Tricuspid Valve Replacement for Infective Endocarditis

Philip Y K Pang  1 , Lily W Y Yang  2   3 , Ling Zhu  2 , Yeow Leng Chua  1
Affiliations

Isolated Tricuspid Valve Replacement for Infective Endocarditis

Philip Y K Pang et al. Cardiol Res. 2022 Apr.

Abstract

Background: Existing data regarding isolated tricuspid valve replacement for primary tricuspid valve disease such as infective endocarditis (IE) are limited. The aim of this study was to review our experience of isolated tricuspid valve replacement for IE.

Methods: A retrospective review was performed to evaluate the perioperative and long-term outcomes of patients undergoing isolated tricuspid valve replacement for IE at our tertiary referral center between January 2000 and December 2014. Surgical outcomes were reviewed to include survival and postoperative complications.

Results: Seven patients underwent isolated tricuspid valve replacement for IE during the study period. Mean age was 41 ± 14 years with six (86%) males. Six patients (86%) were intravenous drug users. Five patients (71%) presented with septic emboli to the lungs. Five patients (71%) had active endocarditis at the time of surgery. The indications for surgery were heart failure in three patients (43%), persistent sepsis in three patients (43%) and both in one patient (14%). Methicillin-sensitive Staphylococcus aureus was the most common infective organism, isolated in five patients (71%). There were no in-hospital mortalities or permanent pacemaker implantations. Follow-up was completed in 86% of the cases. The median follow-up period was 13 months (range 2 to 129 months). Three patients (43%) died during the follow-up period, at 7 months, 8 months and 13 months, respectively. All deaths were associated with prosthetic valve IE and recurrent intravenous drug use.

Conclusions: This study supplements the paucity of data pertaining to tricuspid valve replacement for IE in the local population. Survival outcomes can be improved with prompt surgical intervention, optimal medical optimization, and a holistic, psychosocial approach targeting intravenous drug abuse.

Keywords: Infective endocarditis; Tricuspid regurgitation; Tricuspid valve replacement.

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Conflict of interest statement

The authors have no conflict of interest to declare.

Figures

Figure 1
Figure 1
Preoperative echocardiography. (a, b) Treated endocarditis: (a) Severely dilated tricuspid valve annulus measuring 59 mm (arrows), with non-coapting tricuspid valve leaflets. (b) Dilated tricuspid valve annulus (arrows) measuring 39 mm, with central malcoaptation and severe tricuspid regurgitation. (c, d) Active endocarditis: large, mobile vegetations (arrows) on damaged tricuspid valve leaflets.
See this image and copyright information in PMC

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