Surgical Treatment for Isolated Tricuspid Valve Endocarditis

Baraki, Hassina; Saito, Shunsuke; Ahmad, A. Al; Fleischer, Bernhard; Schmitto, Jan D.; Haverich, Axel; Kutschka, Ingo

doi:10.1253/circj.cj-12-1364

Cited by 32 publications

(43 citation statements)

References 30 publications

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“…Infection resulting from IVDU constitutes approximately 30-40% of all TVIE cases (1,8,9). The IE presentation is with TV lesions in 50-65% of IVDU, and the prevalence of IE in IVDUs is about 2-5% per year (4,9,10).…”

Section: Intravenous Drug Usersmentioning

confidence: 99%

“…CIED lead infection is an increasingly important cause of TVIE (1,3,8). CIED infection should be considered separate from TVIE in that the majority of CIED infections are localized to the device pocket and leads and do not involve the TV.…”

Section: Cardiac Implantable Electronic Device (Cied) Infectionmentioning

confidence: 99%

“…aureus is the predominant causative microorganism for TVIE, occurring in 60-90% of cases in some studies, irrespective of associated risk factors (1,2,4,8). Pseudomonas aeruginosa, other gram-negative microorganisms, fungi, enterococci, streptococci and polymicrobial infections occur less frequently (1).…”

Section: Microbiologymentioning

confidence: 99%

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Tricuspid valve endocarditis

Hussain

Witten

Shrestha

et al. 2017

Ann. Cardiothorac. Surg.

113

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Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (IE), encompassing only 5-10% of cases of IE. Ninety percent of RSIE involves the tricuspid valve (TV). Given the relatively small numbers of TVIE cases operated on at most institutions, the purpose of this review is to highlight and discuss the current understanding of IE involving the TV. RSIE and TVIE are strongly associated with intravenous drug use (IVDU), although pacemaker leads, defibrillator leads and vascular access for dialysis are also major risk factors. Staphylococcus aureus is the predominant causative organism in TVIE. Most patients with TVIE are successfully treated with antibiotics, however, 5-16% of RSIE cases eventually require surgical intervention. Indications and timing for surgery are less clear than for left-sided IE; surgery is primarily considered for failed medical therapy, large vegetations and septic pulmonary embolism, and less often for TV regurgitation and heart failure. Most patients with an infected prosthetic TV will require surgery. Concomitant left-sided IE has its own surgical indications. Earlier surgical intervention may potentially prevent further destruction of leaflet tissue and increase the likelihood of TV repair. Fortunately, TV debridement and repair can be accomplished in most cases, even those with extensive valve destruction, using a variety of techniques.Valve repair is advocated over replacement, particularly in IVDUs patients who are young, non-compliant and have a higher risk of recurrent infection and reoperation with valve replacement. Excising the valve without replacing, it is not advocated; it has been reported previously, but these patients are likely to be symptomatic, particularly in cases with septic pulmonary embolism and increased pulmonary vascular resistance. Patients with concomitant left-sided involvement have worse prognosis than those with RSIE alone, due predominantly to greater likelihood of invasion and abscess formation in left-sided IE. Patients with isolated TVIE have an operative mortality between 0-15% and excellent survival.

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Section: Intravenous Drug Usersmentioning

confidence: 99%

Section: Cardiac Implantable Electronic Device (Cied) Infectionmentioning

confidence: 99%

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Tricuspid valve endocarditis

Hussain

Witten

Shrestha

et al. 2017

Ann. Cardiothorac. Surg.

113

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“…Of note, the patient's CD4 count was 505 cells/mm 3 , and his HIV-1 RNA level was <50 copies/mL (undetectable). A #33 Biocor ® porcine valve (St. Jude Medical, Inc.; St. Paul, Minn) was placed; in addition, defibrillation restored sinus rhythm.…”

Section: Texas Heart Institute Journalmentioning

confidence: 99%

“…Nevertheless, little information is available about intervention when long-standing primary TR is caused by endocarditis. In a retrospective study of 33 patients who underwent surgical repair or replacement for isolated tricuspid valve endocarditis, 3 most did well and had improved functional status. Fourteen of the 33 patients had used intravenous drugs.…”

Section: Texas Heart Institute Journalmentioning

confidence: 99%

Tricuspid Valve Replacement in an HIV-Infected Patient with Severe Tricuspid Regurgitation Secondary to Remote Endocarditis

Myerson¹,

Armstrong²,

Poltavskiy³

et al. 2016

Texas Heart Institute Journal

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Surgical intervention for severe tricuspid regurgitation secondary to remote infective endocarditis has been infrequent, especially in patients also infected with the human immunodeficiency virus (HIV). We describe the case of a 62-year-old HIV-positive man, with a 24-year history of endocarditis caused by intravenous heroin use, who presented with severe tricuspid regurgitation. The patient was initially asymptomatic, was taking antiretroviral medications, and had a satisfactory CD4 count and an undetectable viral load, so we decided to manage the regurgitation conservatively. Two years later, he presented with biventricular heart failure and dyspnea. After surgical tricuspid valve replacement, his condition improved substantially. This case illustrates that HIV-infected patients with complex medical conditions can successfully undergo cardiac surgery.

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