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. 2025 Jul 8;26(7):37204.
doi: 10.31083/RCM37204. eCollection 2025 Jul.

Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis

Mikhail Nuzhdin  1   2 , Yury Malinovsky  1   2 , Maksim Galchenko  3 , Roman Komarov  4 , Aleksey Fokin  2 , Nikita Nadtochiy  1   2
Affiliations

Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis

Mikhail Nuzhdin et al. Rev Cardiovasc Med. .

Abstract

Background: The prevalence of tricuspid valve (TV) infective endocarditis (IE) continues to increase among patients with drug addictions and chronic vascular access or cardiac electronic devices. Moreover, long-term mortality and morbidity following surgery with conventional prostheses remain high. Allografts may represent a suitable alternative in tricuspid surgery. This study aimed to compare outcomes between stented biological valves and mitral allografts (MAs) for tricuspid valve replacement (TVR).

Methods: A total of 54 patients with IE underwent TVR using either a stented bioprosthesis (B) or MA between January 2016 and July 2024. Clinical and echocardiographic data were analyzed in accordance with the Tricuspid-Valve Academic Research Consortium (T-VARC) criteria. Early safety, clinical efficacy, and time-to-event survival were compared between the two equal B and MA groups.

Results: There were no in-hospital or 30-day mortality, nor cardiac, cerebral, and wound complications in either group. The peak and mean pressure gradient (PG) on TV after surgery were 9.2 (6.5-12.0) and 4.0 (3.2-6.0) mmHg in the B group versus 6.0 (4.5-7.5) and 3.0 (2.0-4.0) mmHg in the MA group (p < 0.001). A T-VARC-adjusted analysis demonstrated superior freedom from cardiovascular mortality, recurrent IE, reoperation, and permanent pacemaker implantation (PPI) in the MA group 2 years after operation. Kaplan-Meier analysis revealed significantly higher freedom from cardiovascular mortality in the MA group (100% vs. 81.5%, 77.8%, 77.8%, 69.6% respectively (log-rank test, p = 0.011) at 12-, 18-, 24-, 36-months, and freedom from PPI (100% vs. 81% at all time intervals) (log-rank test, p = 0.021).

Conclusion: Application of contemporary endpoint criteria demonstrated superior outcomes with MA, including lower cardiovascular mortality, reduced PPI, fewer recurrent endocarditis, decreased reoperations, cardiac hospitalizations, alongside improved patient-reported outcomes. Time-to-event analysis demonstrated benefits in cardiovascular survival and PPI avoidance with allografts. Mitral allograft may be a preferable alternative valve substitute for TVR in patients with IE.

Clinical trial registration: ClinicalTrials.gov ID: NCT06591000, https://clinicaltrials.gov/study/NCT06591000?term=NCT06591000&rank=1, registration date: September 19, 2024.

Keywords: allograft; endocarditis; tricuspid valve replacement.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Fig. 1.
Fig. 1.
All-cause mortality. Green dotted line—allograft with 95% CI. Red line—bioprosthesis with 95% CI.
Fig. 2.
Fig. 2.
Cardiovascular mortality. Green dotted line—allograft with 95% CI. Red line—bioprosthesis with 95% CI.
Fig. 3.
Fig. 3.
Endocarditis recurrence. Green dotted line—allograft with 95% CI. Red line—bioprosthesis with 95% CI.
Fig. 4.
Fig. 4.
Permanent pacemaker implantation. Green dotted line—allograft with 95% CI. Red line—bioprosthesis with 95% CI.
Fig. 5.
Fig. 5.
Reoperation. Green dotted line—allograft with 95% CI. Red line—bioprosthesis with 95% CI.
See this image and copyright information in PMC

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References

    1. Iftikhar SF, Ahmad F. Tricuspid Valve Endocarditis . StatPearls Publishing: Treasure Island; 2025. - PubMed
    1. Witten JC, Hussain ST, Shrestha NK, Gordon SM, Houghtaling PL, Bakaeen FG, et al. Surgical treatment of right-sided infective endocarditis. The Journal of Thoracic and Cardiovascular Surgery . 2019;157:1418–1427.e14. doi: 10.1016/j.jtcvs.2018.07.112. - DOI - PubMed
    1. Hamandi M, Smith RL, Ryan WH, Grayburn PA, Vasudevan A, George TJ, et al. Outcomes of Isolated Tricuspid Valve Surgery Have Improved in the Modern Era. The Annals of Thoracic Surgery . 2019;108:11–15. doi: 10.1016/j.athoracsur.2019.03.004. - DOI - PubMed
    1. Darehzereshki A, Mehaffey JH, Hayanga JWA, Wei L, D’etcheverry T, Lagazzi LF, et al. Tricuspid valve surgery for acute infective endocarditis can be performed with very low operative mortality. JTCVS Open . 2024;21:67–75. doi: 10.1016/j.xjon.2024.06.012. - DOI - PMC - PubMed
    1. Slaughter MS, Badhwar V, Ising M, Ganzel BL, Sell-Dottin K, Jawitz OK, et al. Optimum surgical treatment for tricuspid valve infective endocarditis: An analysis of the Society of Thoracic Surgeons national database. The Journal of Thoracic and Cardiovascular Surgery . 2021;161:1227–1235.e1. doi: 10.1016/j.jtcvs.2019.10.124. - DOI - PMC - PubMed

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