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. 2024 May 2;38(5):ivae084.
doi: 10.1093/icvts/ivae084.

Tricuspid valve repair for infective endocarditis

Veronica Lorenz  1 , Stefano Mastrobuoni  1 , Gaby Aphram  1 , Matteo Pettinari  1 , Laurent de Kerchove  1 , Gebrine El Khoury  1
Affiliations

Tricuspid valve repair for infective endocarditis

Veronica Lorenz et al. Interdiscip Cardiovasc Thorac Surg. .

Abstract

Objectives: The progressive increase in the use of implantable electronic devices, vascular access for dialysis and the increased life expectancy of patients with congenital heart diseases has led in recent years to a considerable number of right-side infective endocarditis, especially of the tricuspid valve (TV). Although current guidelines recommend TV repair for native tricuspid valve endocarditis (TVE), the percentage of valve replacements remains very high in numerous studies. The aim of our study is to analyse our experience in the treatment of TVE with a reparative approach.

Methods: This case series includes all the patients who underwent surgery for acute or healed infective endocarditis on the native TV, at the Cliniques Universitaires Saint-Luc (Bruxelles, Belgium) between February 2001 and December 2020.

Results: Thirty-one patients were included in the study. Twenty-eight (90.3%) underwent TV repair and 3 (9.7%) had a TV replacement with a mitral homograft. The repair group was divided into 2 subgroups, according to whether a patch was used during surgery or not. Hospital mortality was 33.3% (n = 1) for the replacement group and 7.1% (n = 2) for repair (P = 0.25). Overall survival at 10 years was 75.6% [95% confidence interval (CI): 52-89%]. Further, freedom from reoperation on the TV at 10 years was 59.3% (95% CI: 7.6-89%) vs 93.7% (95% CI: 63-99%) (P = 0.4) for patch repair and no patch use respectively. Freedom from recurrent endocarditis at 10 years was 87% (95% CI: 51-97%).

Conclusions: Considering that TVE is more common in young patients, a repair-oriented approach should be considered as the first choice. In the case of extremely damaged valves, the use of pericardial patch is a valid option. If repair is not feasible, the use of a mitral homograft is an additional useful solution to reduce the prosthetic material.

Keywords: Endocarditis; Homograft; Infective endocarditis; Tricuspid valve; Valve repair.

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Figures

None
Graphical abstract
Figure 1:
Figure 1:
(A) Repair without patch; (B) repair with patch; and (C) replacement of the tricuspid valve with mitral homograft.
Figure 2:
Figure 2:
Kaplan–Meier curves showing long-term survival for the entire cohort of patients (n = 31).
Figure 3:
Figure 3:
Kaplan–Meier curves showing freedom from reoperation in the repair group with or without patch.
Figure 4:
Figure 4:
Kaplan–Meier curves showing freedom from recurrent endocarditis.
See this image and copyright information in PMC

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