Surgical management of tricuspid valve infective endocarditis in intravenous drug users resulted in a 43% mortality rate at two years compared to 26% with medical management (p=0.522).
Cohort (n=38)
No
Does surgical management improve survival at two years compared to medical management in patients with isolated tricuspid valve infective endocarditis and a history of intravenous drug use?
In IVDU-related tricuspid valve infective endocarditis, surgical management did not significantly improve two-year survival compared to medical management, with ongoing IVDU being the highest risk for mortality.
Absolute Event Rate: 43% vs 26%
p-value: p=0.522
BACKGROUND: Tricuspid valve (TV) infective endocarditis (IE) is a known complication of intravenous drug use (IVDU). This study assessed long-term outcomes of surgically and medically treated cases of TV IE. METHODS: This was a retrospective cohort study of all cases of native TV IE treated in London, Ontario between 2008 and 2011. Outcomes for medically and surgically managed cases were assessed at two years. Outcomes related to the timing of surgery were also assessed. RESULTS: Thirty-eight patients were included; seven received valve surgery: five repairs, two replacements. All patients had a history of IVDU. Baseline characteristics were equal in both groups. Death at two years was 43% in the surgical group and 26% in the nonsurgical group (p = 0.522). In those who received surgery within 30 days versus after 30 days from admission, death was 33% and 50%, respectively (p = 1.00). No patients received emergent surgery (within seven days of admission). Twenty-nine percent of the surgical group survived disease free versus 52% of the nonsurgical group. Survival with morbidity was mainly related to ongoing IVDU. The highest risk for mortality in both groups was ongoing IVDU. CONCLUSIONS: In IVDU-related TV IE the highest risk for mortality appears to be ongoing IVDU and persistent or recurrent endocarditis.
Shetty et al. (Sun,) conducted a cohort in Tricuspid valve infective endocarditis in intravenous drug users (n=38). Surgical management vs. Medical management was evaluated on Death at two years (p=0.522). Surgical management of tricuspid valve infective endocarditis in intravenous drug users resulted in a 43% mortality rate at two years compared to 26% with medical management (p=0.522).