Contemporary Outcomes of Operations for Tricuspid Valve Infective Endocarditis

• Published in: The Annals of thoracic surgery Vol. 99; no. 2; pp. 539 - 546
• Main Authors: Dawood, Murtaza Y., MD, Cheema, Faisal H., MD, Ghoreishi, Mehrdad, MD, Foster, Nathaniel W, Villanueva, Robert M., MPA, Salenger, Rawn, MD, Griffith, Bartley P., MD, Gammie, James S., MD
• Format: Journal Article
• Language: English
• Published: Netherlands Elsevier Inc 01-02-2015
• Subjects: Adult; Aged; Cardiothoracic Surgery; Endocarditis, Bacterial - surgery; Female; Heart Valve Diseases - microbiology; Heart Valve Diseases - surgery; Humans; Male; Middle Aged; Retrospective Studies; Surgery; Treatment Outcome; Tricuspid Valve - surgery; Young Adult; TV; RV; IVDA; methicillin-resistant Staphylococcus aureus; tricuspid valve infective endocarditis; expanded polytetrafluoroethylene; LV; PPM; intravenous drug abuse; MSSA; RHF; SD; tricuspid regurgitation; ASD; patent foramen ovale; MRSA; PFO; left ventricular; ePTFE; IE; 35; tricuspid valve; POD; postoperative day; right ventricular; right heart failure; methicillin-sensitive Staphylococcus aureus; permanent pacemaker; infective endocarditis; hemodialysis; TVIE; HD; atrial septal defect; TR; standard deviation
• ISSN: 0003-4975; 1552-6259
• DOI: 10.1016/j.athoracsur.2014.08.069

Background Tricuspid valve infective endocarditis (TVIE) is uncommon. Patients are traditionally treated with antibiotics alone, and indications for operation are not clearly established. We report our operative single-center experience. Methods We retrospectively reviewed 56 patients who underwent operations for TVIE between January 2002 and December 2012. Results Methicillin-resistant Staphylococcus aureus was present in 41% of patients, septic pulmonary emboli in 63%, moderate/severe tricuspid regurgitation in 66%, and 86% were intravenous drug abusers. Patients underwent early operation if there was concomitant left-sided endocarditis with indications for operation (n = 18), atrial septal defect (n = 6), infected pacemaker lead (n = 4), or prosthetic TVIE (n = 1). The remaining 27 patients were treated with intravenous antibiotics. Five patients completed a 6-week course of intravenous antibiotics before requiring an operation for symptomatic severe tricuspid regurgitation or persistent bacteremia. Twenty-two patients did not complete the antibiotic therapy and underwent operation for symptomatic severe tricuspid regurgitation (n = 15), persistent fevers/bacteremia (n = 3), or patient-specific factors (n = 4). Valve repair was successful in 57% of patients. Overall operative mortality was 7.1%. No operative deaths occurred in patients with isolated native TVIE. Recurrent TVIE was diagnosed in 21% (5 of 24) of the replacement group and in 0% (0 of 32) in the repair group. Use of repair was strongly protective against recurrent TVIE ( p  < 0.01). Conclusions In contrast to previously published reports of high operative mortality with TVIE, this experience demonstrates improved outcomes with low morbidity and mortality, particularly for native isolated TVIE. Future prospective comparisons between surgically and medically treated patients may help to further define indications and timing for operation for patients with TVIE.