Tricuspid Valve Leaflet Repair and Augmentation for Infective Endocarditis

Abstract

Intravenous drug use has increased substantially over the past decade, with heroin abuse more than doubling. Injection drug use-related infective endocarditis hospitalizations have similarly increased over the same period. Right-sided infective endocarditis is strongly associated with intravenous drug use, and 90% of right-sided endocarditis involves the tricuspid valve. During the period of the opioid epidemic, tricuspid-related endocarditis rates have increased, while the incidence of surgery for tricuspid endocarditis has increased as much as five-fold. Within this context, optimizing surgical technique for valve repair is increasingly important. In this report, we examine the indications for tricuspid valve surgery for endocarditis, describe specific techniques for tricuspid valve leaflet repair and augmentation, and assess postoperative care and surgical outcomes after both tricuspid valve repair and replacement for infective endocarditis.

ESC guidelines 2023 on the management of endocarditis

“…751 Tricuspid valve repair is more frequently performed than valve replacement in right-sided IE, although the extent of valve destruction may make repair impossible. 725,752 Tricuspid valve repair may also be associated with better short-and long-term outcomes than replacement for right-sided IE, particularly with regards to recurrent infection and need for repeat surgery. 479,723 When valve replacement for right-sided IE is required, bioprostheses are frequently preferred due to concerns with the management and risks of lifelong anticoagulation, especially in PWID, and the risks of thrombo-embolism for mechanical valves in the right heart.…”

Similar outcome of tricuspid valve repair and replacement for isolated tricuspid infective endocarditis

“…Removal of infected tissue (vegetation, perforated leaflet and abscesses) is the first goal of surgical treatment. Therefore, it could be sometimes necessary for the removal of all leaflets or a part of them, then proceeding to valve reconstruction 21 (autologous pericardium, neochordae, or bicuspidalization techniques). In our series, valve repair and valve replacement were considered.…”

Tricuspid Valve Infective Endocarditis

“…glutaraldehyde-treated autologous pericardium) in order to avoid leaflet distortion. Patching can be done using either interrupted or continuous sutures [66]. In case of annular erosion or abscess, all infected tissue should be debrided until a healthy circumference of tissue is visualized.…”