Surgical and Medical Management of Isolated Tricuspid Valve Infective Endocarditis in Intravenous Drug Users

Abstract

Background: Tricuspid valve (TV) infective endocarditis (IE) is a known complication of intravenous drug use (IVDU). This study assessed long-term outcomes of surgically and medically treated cases of TV IE. Methods: This was a retrospective cohort study of all cases of native TV IE treated in London, Ontario between 2008 and 2011. Outcomes for medically and surgically managed cases were assessed at two years. Outcomes related to the timing of surgery were also assessed. Results: Thirty-eight patients were included; seven received valve surgery: five repairs, two replacements. All patients had a history of IVDU. Baseline characteristics were equal in both groups. Death at two years was 43% in the surgical group and 26% in the nonsurgical group (p = 0.522). In those who received surgery within 30 days versus after 30 days from admission, death was 33% and 50%, respectively (p = 1.00). No patients received emergent surgery (within seven days of admission). Twenty-nine percent of the surgical group survived disease free versus 52% of the nonsurgical group. Survival with morbidity was mainly related to ongoing IVDU. The highest risk for mortality in both groups was ongoing IVDU. Conclusions: In IVDU-related TV IE the highest risk for mortality appears to be ongoing IVDU and persistent or recurrent endocarditis.

Tricuspid valve endocarditis in the era of the opioid epidemic

“…Frequently, patients are referred to a medical service and receive maximal antibiotic therapy as the primary treatment modality. Surgical referral and intervention is often reserved for those patients who develop severe heart failure, septic embolization, ongoing septicemia, or “fail medical therapy.” However, several groups have noted that earlier operative intervention improves survival . Our data suggest that patients presenting with tricuspid endocarditis in the setting of intravenous drug abuse are increasingly younger and have less comorbidities than the overall surgical population.…”

A case of tricuspid valve infective endocarditis in intravenous drug use

“…This illustrating the need to attempt to clarify future behaviours and address the underlying issue of addiction. Safe injecting rooms are controversial amongst the general population, although studies have shown a decrease in IE in IVDUs from the use of sterile equipment 13 …”

The role of percutaneous vacuum-assisted thrombectomy for intracardiac and intravascular pathology

“…Though small in number, results have been promising for tricuspid valve infective endocarditis. Surgeons may be hesitant to replace the TV in the patients with active or recurrent IV drug abuse or multiple co‐morbidities . VAT may debulk these vegetations and allow for medical therapy without the need for surgical intervention.…”