Valvectomy Versus Replacement for the Surgical Treatment of Tricuspid Endocarditis

Abstract

Tricuspid valve endocarditis patients who undergo tricuspid valve excision, repair, and replacement have similar 30-day operative mortality, as defined by The Society of Thoracic Surgeons. Excision patients have significantly lower unplanned readmission rates at 1 year. Tricuspid valvectomy is an acceptable initial treatment in this high-risk group as part of a surgical strategy to identify patients who are candidates for eventual valve replacement. Further study of long-term outcomes and survival is warranted.

Valvectomy versus replacement for the surgical treatment of infective tricuspid valve endocarditis: a systematic review and meta-analysis

“…In a single-center retrospective study comparing patients with IVDU-associated isolated tricuspid infective endocarditis, there were no differences in 30-day operative mortality, bleeding requiring reoperation, major stroke, prolonged ventilator time, intensive care unit and hospital length of stay between patients who underwent tricuspid valvectomy or replacement (13). Furthermore, Protos et al (13) demonstrated that patients who underwent tricuspid valvectomy had significantly lower unplanned hospital readmission rates at 1 year, compared to those who underwent replacement.…”

“…In a single-center retrospective study comparing patients with IVDU-associated isolated tricuspid infective endocarditis, there were no differences in 30-day operative mortality, bleeding requiring reoperation, major stroke, prolonged ventilator time, intensive care unit and hospital length of stay between patients who underwent tricuspid valvectomy or replacement (13). Furthermore, Protos et al (13) demonstrated that patients who underwent tricuspid valvectomy had significantly lower unplanned hospital readmission rates at 1 year, compared to those who underwent replacement. An important recent study of surgical outcomes for isolated IVDU-associated tricuspid valve infective endocarditis, utilizing The Society of Thoracic Surgeons (STS) adult cardiac surgery database, and using a contemporary cohort of patients demonstrates that valvectomy was an independent predictor of operative mortality (14).…”

“…The decision of choice and whether to offer surgical therapy for patients with IVDU-associated infective tricuspid valve endocarditis is a complex one-with social considerations (willingness to abstain from IVDU, compliance with antibiotic therapy stable income, stable housing, detoxification and rehabilitation), clinical considerations (size of vegetations, extension of abscess, comorbid HIV and hepatitis C infection) and ethical considerations (prolong life expectancy, risk of recurrence, healthcare expenditures and resource allocation) (15). IVDU is an independent predictor of death in patients with endocarditis and should be considered strongly in surgical recommendations for this complicated population (1,13,17).…”

Inconsistent Addiction Treatment for Patients Undergoing Cardiac Surgery for Injection Drug Use-Associated Infective endocarditis

“…As rates of IDU-IE requiring surgical intervention have been increasing throughout the opioid epidemic nationally, 5,13 cardiac surgeons have been deliberating on the best way to care for these patients. Due to the risk of recurrence/reinfection associated with drug use 14 and the limited nature of resources, different strategies have been proposed.…”

Invited Commentary

“…Protos and colleagues [1] performed a single-center, retrospective, smaller sample size (n ¼ 63) study that compared 3 surgical approaches for the treatment of tricuspid valve endocarditis: repair (n ¼ 12), valve replacement (n ¼ 26), and valvectomy (n ¼ 25). They found that there was no difference in mortality between the groups, with only 1 death and an overall 30-day mortality of 1.6%.…”