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. 2024 Jun 28:21:67-75.
doi: 10.1016/j.xjon.2024.06.012. eCollection 2024 Oct.

Tricuspid valve surgery for acute infective endocarditis can be performed with very low operative mortality

Ali Darehzereshki  1 , J Hunter Mehaffey  1 , J W Awori Hayanga  1 , Lawrence Wei  1 , Taylor D'etcheverry  1 , Luigi F Lagazzi  1 , Vinay Badhwar  1
Affiliations

Tricuspid valve surgery for acute infective endocarditis can be performed with very low operative mortality

Ali Darehzereshki et al. JTCVS Open. .

Abstract

Objective: Tricuspid valve surgery historically has been perceived as having elevated operative risk, prompting the recent development of transcatheter therapies including aspiration vegetectomy for endocarditis. The opioid epidemic has exacerbated tricuspid valve endocarditis, particularly in people who inject drugs. We sought to evaluate contemporary outcomes of tricuspid valve surgery in real-world practice.

Methods: An institutional multidisciplinary endocarditis database inclusive of clinical, microbiologic, and echocardiographic data was analyzed for those undergoing isolated or concomitant tricuspid valve surgery for acute active endocarditis. Consecutive patients between 2016 and 2021 were followed for longitudinal outcomes.

Results: A total of 283 patients with tricuspid valve endocarditis underwent tricuspid valve repair (n = 137, 48.4%) or replacement (n = 146, 51.6%). Median age was 31 (27-37) years, 63.1% were female, and 257 (90.8%) were active people who inject drugs. The leading indications for surgery were severe valvular insufficiency (71.2%), vegetation size greater than 2 cm (51.3%), or septic shock (23.3%). Concomitant procedures were performed in 44 patients (15.5%). In patients who underwent isolated tricuspid valve surgery (n = 239), no patient required permanent pacemaker after tricuspid valve repair, whereas 13.3% required permanent pacemaker after tricuspid valve replacement. Overall and isolated tricuspid valve surgery operative mortality were 1.8% and 1.3%, respectively. Overall and isolated tricuspid valve surgery 1-year survivals were 89.3% and 89.7%, respectively.

Conclusions: Tricuspid valve surgery for endocarditis has low operative mortality. When feasible, repair is preferred over replacement. In an era of promulgation of investigational therapies, heart teams should note that tricuspid valve surgery is low risk and remains the first-line beyond antibiotics.

Keywords: cardiac surgery; endocarditis; injection drug use; tricuspid valve.

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Conflict of interest statement

The authors reported no conflicts of interest. The Journal policy requires editors and reviewers to disclose conflicts of interest and to decline handling or reviewing manuscripts for which they may have a conflict of interest. The editors and reviewers of this article have no conflicts of interest.

Figures

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Overall survival after TV surgery for IE.
Figure 1
Figure 1
Kaplan–Meier overall survival after TV surgery for IE. Kaplan–Meier survival curve of patients undergoing surgical intervention for TV IE with 95% CIs (dotted lines) and number at risk.
Figure 2
Figure 2
Kaplan–Meier survival after isolated TV repair versus replacement for IE. Kaplan–Meier survival curve of patients undergoing isolated TV surgery for IE stratified by repair (blue) versus replacement (red) with 95% CIs (dotted lines) and number at risk. TVr, Tricuspid valve replacement; TVR, tricuspid valve repair.
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