Surgical management of isolated tricuspid valve endocarditis has low operative mortality but is burdened by high rates of recurrence, readmission, and reoperation, particularly in patients with a history of intravenous drug use.
Introduction: Tricuspid valve endocarditis (TVIE) is a serious disease that carries high morbidity and mortality. It is commonly seen in patients who administer drugs intravenously. The aim of this study is to review the outcomes of surgical treatments for TVIE. This is a retrospective chart review of 48 patients who received surgical treatment for TVIE at an urban tertiary care center between January 1, 2010 and December 31, 2021. Material and methods: The 48 patients in our study ranged from age 18-54 and were composed of 34 women and 14 men, including 47 White and 1 African American. All but one patient were IV drug users (IVDU). The most common presenting symptoms were fever, chills, dyspnea, chest pain, and myalgias. All patients received preoperative antibiotic regimens for around 6 weeks. Surgical interventions included 38 tricuspid valve replacements, 5 tricuspid repairs, and 5 AngioVac debulking procedures. Results: Outcomes include 30-Day mortality in 1 patient, 90-Day Mortality in 2 patients and Over 90-Day Mortality in 3 patients. Postoperative complications include complete heart block (8), bleeding (1), fluid volume overload (1), and 1 patient experienced cardiogenic shock and multiple organ failure postoperatively. Thirty-two patients had readmissions during the study, twenty-two of which were due to recurrence of TVIE. Thirteen patients required reoperations following their initial operation. Conclusions: Although patients benefit from antibiotic treatment, surgical intervention is required when infection leads to structural damage of the tricuspid valve. However, risk for recurrence of TVIE in IVDUs places a burden on the long-term success rates of surgical management.
More et al. (Fri,) studied this question.