Surgical Management of Tricuspid Valve Infective Endocarditis: A Systematic Review and Meta-Analysis

Yanagawa, Bobby; Elbatarny, Malak; Verma, Subodh; Hill, Samantha; Mazine, Amine; Puskas, John D.; Friedrich, Jan O.

doi:10.1016/j.athoracsur.2018.04.012

Cited by 39 publications

(15 citation statements)

References 30 publications

(80 reference statements)

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“…In keeping with published data, early surgery is a choice in case of IE with Staphylococcus aureus or fungal infection [1,16,80]. Early surgery of tricuspid valve IE is considered when associates (1) atrial septal defect; (2) prosthetic valve endocarditis; (3) infected pacing leads; (4) indwelling catheters; and (5) simultaneous left-sided IE [81,82]. Additionally, development of bacteremia or pulmonary septic emboli also has early surgery.…”

Section: Timing Of Surgerymentioning

confidence: 94%

Infective Endocarditis in Intravenous Drug Users: Surgical Treatment

Moldovan¹,

Molnar²,

Costache³

et al. 2019

Infective Endocarditis

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Intravenous drug use is associated with infective endocarditis. Besides, it does appear that left-sided infective endocarditis is a feature of general population, whereas right-sided infective endocarditis is common in intravenous drug users. The most common etiology of right-sided infective endocarditis in intravenous drug users is Staphylococcus aureus in about 75% followed by streptococci, Gramnegative bacilli and fungi. In case of intravenous drug users with infective endocarditis, optimal treatment strategies lack a general consensus. Additionally, the best indication and timing of surgery are debatable. To overcome these problems, the early and complete surgical debridement of infected tissue together with microbial therapy assures a good prognosis in the long term.Keywords: endocarditis, drug-associated endocarditis, intravenous drug abuser endocarditis, intravenous drug users, right heart endocarditis Infective Endocarditis 2 the right-sided IE, tricuspid valve is affected in 90% cases [21], whereas pulmonic valve represents about 10% from right-sided IE cases [3,18,24]. Up to now, isolated right-sided IE involving the pulmonary valve, the eustachian valve, interventricular septum, or right ventricular free wall have been described [17,21,25]. MicrobiologyAccording to current evidence, IE among IDUs presents a large spectrum of microbial pathogens (Table 1) [26][27][28][29][30][31].Pathogens as Pseudomonas aeruginosa, other gram-negative microorganisms, fungi, enterococci, streptococci, and polymicrobial infections occur less frequently [16]. Importantly, other pathogens noted in IDUs are oral bacteria such as Prevotella intermedia, Haemophilus parainfluenzae, S. constellatus, and E. corrodens [32][33][34][35][36].The most common etiology of right-sided IE in IDUs is Staphylococcus aureus (S. aureus) in about 75% [1,4,6,[37][38][39] followed by streptococci, Gram-negative bacilli, and fungi [40]. In fact, published data supports the involvement of S. aureus among IDUs in 40-74% cases of IE [38,41,42]. S. aureus is the most common cause of tricuspid valve endocarditis regardless of associated risk factors in IDUs [1,4,16,18,43].The incidence of negative blood cultures is reported as 2.5-31% and is associated with delayed diagnosis and treatment [44], with large vegetations [45], and with highest morbidity and mortality [16,45,46].Regarding HIV, a prevalence of HIV as high as 60% among IDUs has been reported by centers from Europe and the USA [11,40]. HIV is more common among IDUs with right-sided IE than left-sided IE [47].Polymicrobial endocarditis is characteristically for IDUs [48] and may involve microorganisms such as Bartonella spp., Candida spp., or Tropheryma whipplei [49]. The presence of E. corrodens should aware the likelihood of polymicrobial IE with embolic complications and relapses. In fact, there is a synergism between streptococci and E. corrodens [50][51][52].

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Section: Timing Of Surgerymentioning

confidence: 94%

Infective Endocarditis in Intravenous Drug Users: Surgical Treatment

Moldovan¹,

Molnar²,

Costache³

et al. 2019

Infective Endocarditis

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show abstract

“…TV repair was possible in 2/3 of these patients and the majority underwent TV replacement with a bioprosthesis. The authors concluded that both TV repair and replacement have good long-term survival, but repair is associated with less risk of need for pacemaker, recurrence of infection and reoperation [44].…”

Section: Surgical Outcomesmentioning

confidence: 99%

Surgery for Tricuspid Valve Endocarditis in the Current Era

Said¹

2021

Advanced Concepts in Endocarditis - 2021

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Tricuspid valve endocarditis (TVE) continues to be on the rise and has been mostly attributed to the growing epidemic of intravenous drug abuse (IVDA). Other risk factors include long-term indwelling central venous catheters and implantable cardiac devices. While medical management continues to be the first line therapy, surgery is indicated when medical management fails, and in the presence of hemodynamic deterioration, recurrent septic pulmonary embolization and/or persistent sepsis. Tricuspid valve (TV) excision once was the main surgical strategy, but other options include TV repair/reconstruction and replacement. Remaining challenges include management of drug-induced endocarditis and the best strategy for recurrent infection.

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“…Valvectomy with valve replacement as a staged procedure can allow patients to self-select in terms of their ability to maintain adequate follow-up, undergo detoxification and drug rehabilitation, optimize their social and financial situation, and demonstrate abstinence from IVDU prior to tricuspid valve replacement. However, valvectomy is largely falling out of favor due to the potential of severe right heart failure and the ventricularization of right atrial pressures [13,15]. In patients with normal heart function pre valvectomy, severe right heart failure with symptoms of peripheral edema and ascites can occur within 6-9 months post valvectomy [6].…”

Section: Current Surgical Optionsmentioning

confidence: 99%

Contemporary and Evolving Treatment of Tricuspid Endocarditis

Ayzenbart¹

2021

Advanced Concepts in Endocarditis - 2021

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The current treatment paradigm for right sided infective endocarditis is rapidly evolving. The existing recommendations for right sided infective endocarditis include medical therapy with surgical therapy used in certain situations. Surgical therapy is based on the size of the vegetation, presence of infective complications and certain causative organisms as well the retention of intracardiac devices. Unfortunately, medical therapy alone is usually not enough to clear the infection, especially when intravenous drug use is associated as the etiology. Intravenous drug use is associated with a high rate of recidivism in tricuspid valve endocarditis. Even with indications for surgery, these patients present an ethical dilemma as most of these patients will re-infect their valves post-surgery. This often provides little option than for the surgeon to re-operate in a setting with a higher risk of mortality and morbidity. We present an evolving technique of percutaneous extirpation of vegetation, allowing for rapid clearance of endocarditis, less chance of failure of medical therapy with a lower risk profile for complication.

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Surgical Management of Tricuspid Valve Infective Endocarditis: A Systematic Review and Meta-Analysis

Abstract: Tricuspid valve repair and replacement offer similar long-term survival. Valve repair may offer greater freedom from recurrent IE and reoperation as well as freedom from pacemaker and should be the preferred approach for patients with tricuspid valve IE.

Cited by 39 publications

References 30 publications

Infective Endocarditis in Intravenous Drug Users: Surgical Treatment

Infective Endocarditis in Intravenous Drug Users: Surgical Treatment

Surgery for Tricuspid Valve Endocarditis in the Current Era

Contemporary and Evolving Treatment of Tricuspid Endocarditis

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