Surgical treatment of isolated tricuspid valve infective endocarditis: 25-year results from a multicenter registry

Mauro, Michele Di; Foschi, Massimiliano; Dato, Guglielmo Mario Actis; Centofanti, Paolo; Barili, Fabio; Corte, Alessandro Della; Ratta, Ester Della; Cugola, Diego; Galletti, Lorenzo; Santini, Francesco; Salsano, Antonio; Rinaldi, Mauro; Mancuso, Samuel; Cappabianca, Giangiuseppe; Beghi, Cesare; Vincentiis, Carlo De; Biondi, Andrea; Livi, Ugolino; Sponga, Sandro; Pacini, Davide; Murana, Giacomo; Scrofani, Roberto; Antona, Carlo; Cagnoni, G; Nicolini, Francesco; Benassi, Filippo; Bonis, Michele De; Pozzoli, Alberto; Casali, Giovanni; Scrascia, Giuseppe; Falcetta, Giosuè; Bortolotti, Uberto; Musumeci, Francesco; Gherli, Riccardo; Vizzardi, Enrico; Salvador, Loris; Picichè, Marco; Paparella, Domenico; Margari, Vito; Troise, Giovanni; Villa, Emmanuel; Dossena, Yudit; Lucarelli, Carla; Onorati, Francesco; Faggian, Giuseppe; Mariscalco, Giovanni; Maselli, Daniele; Parolari, Alessandro; Lorusso, Roberto

doi:10.1016/j.ijcard.2019.05.020

Cited by 28 publications

(23 citation statements)

References 26 publications

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“…PWID have traditionally been responsible for the majority of ND-RSID (Habib et al, 2015;Mi et al, 2016;Ortiz et al, 2014) but accounted for only forty percent of patients with ND-RSIE in our study. However, this relatively low prevalence of IDU is similar to that found in a 2019 study by Di Mauro et al comprising patients with isolated tricuspid valve IE (Di Mauro et al, 2019). We believe this estimation to be fairly accurate based on healthcare professionals being observant and well trained in identifying patients with IDU.…”

Section: Discussionsupporting

confidence: 87%

The epidemiology of infective endocarditis with focus on non-device related right-sided infective endocarditis: A retrospective register-based study in the region of Southern Denmark

Lassen

Nielsen

Gill

et al. 2020

International Journal of Infectious Diseases

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Non-device related right-sided infective endocarditis (ND-RSIE) is not well characterized. We aimed to characterize patients with infective endocarditis (IE) with emphasis on the epidemiology, clinical characteristics and complications of ND-RSIE. Methods: In this population-based cohort study, we identified patients with IE using ICD-10 codes from the Danish National Hospital Register in the Region of Southern Denmark between January 2007 and May 2017. Hospital records were reviewed, and characteristics and outcomes recorded. Results: We included 1243 confirmed IE episodes of which 82% were left-sided IE, 11% were cardiac device right sided infective endocarditis (RSIE) and 7% were ND-RSIE. Patients with ND-RSIE were considerably younger, had less comorbidity and had a lower 30-day mortality (6%) compared with patients with device RSIE (24%) and left-sided IE (26%) (p < 0.01). ND-RSIE was associated with underlying heart disease, involvement of the tricuspid valve (57%), Staphylococcus species (53%) and complications (61%). Forty percent of ND-RSIE occurred among people who inject drugs (PWID) for whom significant differences were observed compared with non-PWID with regards to tricuspid valve involvement (96% vs. 32%), causative microorganisms (Staphylococcus aureus 79% vs. 27%), complications (86% vs. 45%), recurrence (29% vs. 11%) and 30-day mortality (0% vs. 7%). Conclusion: ND-RSIE is relatively rare and differs with regards to epidemiology, clinical characteristics and complications compared with left-sided IE and cardiac device RSIE, but has a favourable prognosis. Forty percent of ND-RSIE occurs among PWID, which is associated with frequent complications but a very low mortality.

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Section: Discussionsupporting

confidence: 87%

The epidemiology of infective endocarditis with focus on non-device related right-sided infective endocarditis: A retrospective register-based study in the region of Southern Denmark

Lassen

Nielsen

Gill

et al. 2020

International Journal of Infectious Diseases

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“…A total of 811 entries were obtained from the literature search, and figure 1 summarises the studies disposition. After abstract screening, 54 full-text studies were evaluated before arriving at the final 16 studies that met the inclusion criteria of this meta-analysis 6–21Table 1. lists the main characteristics of the included studies, totalling 6808 isolated tricuspid valve repairs and 8261 isolated tricuspid valve replacement patients.…”

Section: Resultsmentioning

confidence: 99%

Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients

et al. 2020

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ObjectivesTricuspid valve disease is increasingly encountered, but surgery is rarely performed in isolation, in part because of a reported higher operative risk than other single-valve operations. Although guidelines recommend valve repair, there is sparse literature for the optimal surgical approach in isolated tricuspid valve disease. We performed a meta-analysis examining outcomes of isolated tricuspid valve repair versus replacement.MethodsWe searched Pubmed, Embase, Scopus and Cochrane from January 1980 to June 2019 for studies reporting outcomes of both isolated tricuspid valve repair and replacement, excluding congenital tricuspid aetiologies. Data were extracted and pooled using random-effects models and Review Manager 5.3 software.ResultsThere were 811 article abstracts screened, from which 52 full-text articles reviewed and 16 studies included, totalling 6808 repairs and 8261 replacements. Mean age ranged from 36 to 68 years and females made up 24%–92% of these studies. Pooled operative mortality rates and odds ratios (95% confidence intervals) for isolated tricuspid repair and replacement surgery were 8.4% vs 9.9%, 0.80 (0.64 to 1.00). Tricuspid repair was also associated with lower in-hospital acute renal failure 12.4% vs 15.6%, 0.82 (0.72 to 0.93) and pacemaker implantation 9.4% vs 21.0%, 0.37 (0.24 to 0.58), but higher stroke rate 1.5% vs 0.9%, 1.63 (1.10 to 2.41). There were no differences in rates of prolonged ventilation, mediastinitis, return to operating room or late mortality.ConclusionIsolated tricuspid valve repair was associated with significantly reduced in-hospital mortality, renal failure and pacemaker implantation compared with replacement and is therefore recommended where feasible for isolated tricuspid valve disease, although its higher stroke rate warrants further research.

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“…The broad spectrum of TV pathology gained increasing interest over time in the surgical community, although it has been considered for many years as “The Forgotten Valve.” Data from the National Inpatient Sample files showed a significant increase of the number of isolated TV operations performed annually in the United States from 2004 to 2013 and unchanged in‐hospital mortality despite increasing surgical volumes 16 . Most of the existing literature about isolated TV surgery relies on studies analyzing previous standards in terms of indications and surgical techniques 3–9,13 . Conversely, our analysis targeted a cohort of patients operated for isolated TV surgery over the last decade comparing the results of BH and AH technique.…”

Section: Discussionmentioning

confidence: 99%

“…Owing to the dismal natural history of untreated TR, current European Guidelines recommend a surgical intervention in asymptomatic patients in case of tricuspid annular dilatation and/or right ventricular dysfunction 2 . However, TV surgery is usually performed as a concomitant procedure with a mitral valve operation and the existing literature about isolated TV surgery is sparse 3–15 . Although isolated TV surgery has historically been associated with high mortality rates, growing evidence suggests a trend toward improved outcomes 15–17 .…”

Section: Introductionmentioning

confidence: 99%

Beating versus arrested heart isolated tricuspid valve surgery: An 11‐year experience in the current era

Flagiello¹,

Grinberg

Connock

et al. 2021

J Card Surg

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Background and aim of the study Data about the beating heart (BH) technique for isolated tricuspid valve (TV) surgery compared to the arrested heart (AH) technique are sparse. We compared the outcomes of isolated TV surgery between BH and AH technique. Methods We performed an observational analysis of our database of isolated TV surgery. Patients were divided into two groups according to whether surgery was performed without (BH group) or with (AH group) aortic cross‐clamping and cardioplegic arrest. The primary endpoint was survival to hospital discharge. Risk factors for in‐hospital mortality were searched with multivariate analyses. We undertook further comparisons after propensity‐score matching. Results From January 2007 to December 2017, we performed 82 isolated TV surgery (BH group, n = 47, 57.3%; AH group, n = 35, 42.7%). The mean age was 59.1 years, 56.1% were female. BH group patients were older (61.8 vs. 55.4 years; p = .035), had greater impaired renal function (glomerular filtration rate, 61.1 vs. 74.6 ml/min; p = .012), were more frequently operated for secondary TR (61.7 vs. 31.4%; p = .008), underwent more frequently a reoperation (53.2 vs. 28.6%; p = .042) and exhibited a higher surgical risk (EuroSCORE II, 3.92 vs. 2.50%; p = .013). In‐hospital mortality was not different between both groups, either considering unmatched (BH = 10.6 vs. AH = 5.7%; OR = 1.96, 95% confidence interval [CI] = 0.36–10.77) or matched populations (BH = 10.6 vs. AH = 6.4%; OR = 1.89, 95% CI = 0.36–9.97). Age was the only predictor of in‐hospital mortality. Conclusions The BH technique showed comparable outcomes to the AH technique for isolated TV surgery despite a higher risk profile.

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Surgical treatment of isolated tricuspid valve infective endocarditis: 25-year results from a multicenter registry

Cited by 28 publications

References 26 publications

The epidemiology of infective endocarditis with focus on non-device related right-sided infective endocarditis: A retrospective register-based study in the region of Southern Denmark

The epidemiology of infective endocarditis with focus on non-device related right-sided infective endocarditis: A retrospective register-based study in the region of Southern Denmark

Isolated surgical tricuspid repair versus replacement: meta-analysis of 15 069 patients

Beating versus arrested heart isolated tricuspid valve surgery: An 11‐year experience in the current era

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