BACKGROUND: Intravenous drug abuse (IVDA) has increased the incidence of infective endocarditis. Standard management includes traditional open surgery and more recently described percutaneous tricuspid valve debulking. Study goals were to compare clinical outcomes and identify financial differences between percutaneous tricuspid debulking and tricuspid surgery for isolated tricuspid valve endocarditis. METHODS: A single-center, retrospective cohort patient study of isolated tricuspid valve endocarditis was performed. Patients underwent either percutaneous debulking with the AngioVac system (n=14, 83% IVDA) or tricuspid valve surgery (n=23, 76% IVDA). Length of stay, readmission rates, mortality, echocardiographic parameters, hematologic markers, transfusion rates, and total charges for index hospitalization were evaluated between groups. RESULTS: In patients who underwent either percutaneous debulking or open surgery, length of stay (17±17 vs 20±13 days, p=0. 48), 30-day readmission (29% vs 26%, p=0. 87), in-hospital mortality (7% vs 0%, p=0. 20), and 30-day mortality (7% vs 0%, p=0. 20) were not statistically different. One-year mortality (21% vs 4%, p=0. 11) trended toward but did not reach significance. Postoperative tricuspid valve regurgitation (2. 5±1. 1 vs 1. 0±0. 3, p<0. 0001) and transfusion rates (2±3 vs 6±6 units, p=0. 02) were significantly different between therapies. Total charges for hospitalization were not statistically different (557, 066±457, 520 vs 571, 615±324, 254, p=0. 91). CONCLUSIONS: Tricuspid debulking is a potential alternative to surgery for patients with infective tricuspid endocarditis. Similar outcomes, costs, and avoidance of prosthetic material in patients with active IVDA are potential benefits.
Ramdeen et al. (Mon,) studied this question.