Bioprosthetic tricuspid valve replacement for tricuspid valve endocarditis secondary to infected endocardial pacemaker leads

Xu, Zhiwei; Shi, Qiuxia; Mei, Ju; Tan, Yan

doi:10.1111/jocs.12878

Cited by 4 publications

(2 citation statements)

References 14 publications

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“…When tricuspid valve endocarditis is associated with pacing leads, the lead, and pacemaker generator needs to be completely excised. In those cases, where the tricuspid valve cannot be repaired and TVR is necessary, the placement of permanent epicardial pacing leads is advised …”

Section: Discussionmentioning

confidence: 99%

Tricuspid valve replacement with mechanical prostheses: Short and long-term outcomes

et al. 2017

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In this series of mechanical tricuspid valve replacements in patients with predominately rheumatic heart disease, operative and long-term mortality were increased; however, survivors had significant improvement in their NYHA class and freedom from right heart failure symptoms. Three preoperative factors (age, diabetes mellitus, and coronary artery disease) were independently associated with long-term mortality.

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Section: Discussionmentioning

confidence: 99%

Tricuspid valve replacement with mechanical prostheses: Short and long-term outcomes

et al. 2017

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“…The pacemaker generator or lead change is the higher factor of risk for IE on the cardiac device. The tricuspid valve is the most common site of RSIE associated with this kind of devices [7,35].…”

Section: Intracardiac Devices (Icd)mentioning

confidence: 99%

Right-Sided Infective Endocarditis

Muñoz¹,

Vargas²

2019

Infective Endocarditis

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Infective endocarditis (IE) at the right side represents the 5-10% of IE cases. It is more frequent in people with intravenous drug addiction (IVDA); however, there is another population susceptible to this infection; hemodialytic patients, intracardiac devices, and congenital heart diseases are included inside this group. Right-sided infective endocarditis (RSIE) has lower mortality than the left-sided infective endocarditis (LSIE). Common symptoms secondary to right-sided endocarditis are the respiratory symptoms characterized by a cough, hemoptysis, persistent fever, dyspnea, and chest pain. Echocardiography and blood cultures are the first tools to perform the diagnosis. The tricuspid valve is the main anatomical structure affected. Medical treatment with antibiotic therapy resolves the infection majority of the time; the surgical treatment is indicated in some cases, such as right-heart failure due to severe tricuspid valve regurgitation; inability to eliminate bacteremia or organism; resistance to culture-directed antibiotic treatment, within 7 days; and tricuspid valve vegetations >20 mm. RSIE implies a better prognosis than LSIE. Concomitant left-sided IE carries a worse prognosis than right-sided infection alone, due predominantly to its greater likelihood for invasion and abscess formation.

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

Luc¹,

Choi²,

Kodia³

et al. 2019

Ann. Cardiothorac. Surg.

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Background: Optimal surgical treatment of infective tricuspid valve endocarditis in patients with intravenous drug use (IVDU) remains controversial. Tricuspid valvectomy has been proposed for infective tricuspid valve endocarditis in this patient population given the inherent social concerns. The aim of this systematic review and meta-analysis was to compare outcomes of valvectomy versus replacement for the surgical treatment of isolated infective tricuspid valve endocarditis. Methods: An electronic search was performed to identify all relevant studies published. After assessment for inclusion and exclusion criteria, 16 original studies were pooled for systematic review and meta-analysis. Results: There were a total of 752 patients with infective tricuspid valve endocarditis, of which 14% underwent valvectomy and 86% underwent replacement (mean follow-up 4.2 years, 95% CI, 1.9-6.4 years). The most common indications for surgical intervention were septic pulmonary embolism in the valvectomy group (74%, 95% CI, 28-95%) and persistent sepsis in the replacement group (62%, 95% CI, 31-86%). There were no differences in rates of stroke [valvectomy 4% (95% CI, 1-11%) vs. replacement 3% (95% CI, 1-16%), P=0.85] but there was increased likelihood of prolonged ventilation in those who underwent valvectomy [valvectomy 40% (95% CI, 30-51%) vs. replacement 26% (95% CI, 23-30%), P<0.01]. There were no differences in 30-day post-operative mortality [valvectomy 13% (95% CI, 5-30%) vs. replacement 7% (95% CI, 5-10%), P=0.21], post-operative right heart failure [valvectomy 27% (95% CI, 10-53%) vs. replacement 11% (95% CI, 5-25%), P=0.17] and recurrent endocarditis [valvectomy 7% (95% CI, 2-23%) vs. replacement 19% (95% CI, 12-28%), P=0.81]. Valvectomy had a higher rate of tricuspid valve reoperation [valvectomy 56% (95% CI, 15-90%) vs. initial replacement 14% (95% CI, 7-27%), P=0.06]. Conclusions: Tricuspid valvectomy is an acceptable initial therapy for infective tricuspid valve endocarditis in patients with IVDU, providing a bridge to identify those who will self-select as candidates for staged valve replacement.

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Bioprosthetic tricuspid valve replacement for tricuspid valve endocarditis secondary to infected endocardial pacemaker leads

Abstract: Bioprosthetic TVR can be performed with acceptable morbidity and mortality in severe tricuspid endocarditis due to infected endocardial pacemaker leads.

Cited by 4 publications

References 14 publications

Tricuspid valve replacement with mechanical prostheses: Short and long-term outcomes

Tricuspid valve replacement with mechanical prostheses: Short and long-term outcomes

Right-Sided Infective Endocarditis

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

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