Comparison of valvuloplasty and replacement for surgical treatment of tricuspid infective endocarditis

Abstract

Background Owing to the increase in both intravenous drug injections and intracardiac and vascular interventional treatments among drug users, the incidence of infective endocarditis (IE) involving the tricuspid valve, which sits between the two right heart chambers, has gradually increased. This study aimed to compare the clinical outcomes of different surgical procedures for tricuspid infective endocarditis (TIE). Methods We retrospectively analyzed fifty-six patients who underwent tricuspid valve surgery at our hospital from January 2006 to August 2019. All patients were diagnosed with TIE and indicated a need for surgery. Perioperative and follow-up data were collected to summarize and analyze the clinical outcomes of different surgical approaches, including tricuspid valvuloplasty (TVP) and tricuspid valve replacement (TVR) for TIE. Results Cardiopulmonary bypass (CPB) time, aortic cross-clamp (ACC) time, postoperative mechanical ventilation time, and intensive care unit (ICU) stay time were shorter in the TVP group than in the TVR group. Additionally, the incidence of red blood cell transfusion and postoperative complications was lower in the TVP group than in the TVR group. The postoperative 30-day mortality rates were similar between both the groups. Fifty-two patients were followed up for an average of 5.50 ± 3.79 years. The postoperative 3-, 5-, and 7-year survival rates were 100%, 100%, and 95.5% in the TVP group and 96.7%, 96.7%, and 96.7% in the TVR group, respectively. The 5-year and 10-year reoperation rates were 0% and 0% in the TVP group and 6.7% and 20% in the TVR group, respectively. Conclusion Both TVR and TVP for TIE significantly improved the functional status of the heart with satisfactory efficacy. TVP was found to be superior to TVR in reducing the need for postoperative blood transfusions, reducing the risk of postoperative complications, and reducing the need for long-term reoperations.

Transfusion of blood products in cardiac surgery for endocarditis: predictors and consequences

“…The impact of confounding factors was reduced by using the inverse probability of treatment weighting on the propensity score (Lee et al, 2021). A small scale series patients with tricuspid valve IE confirmed this observation: there was a lower transfusion need for RBC in patients undergoing repair compared to replacement, while both procedures were effective in improving the cardiac status (Xie et al, 2023). The mode of access had also an effect: minimal invasive access mitral surgery for native valve IE, compared to full sternotomy, showed a lower transfusion rate of RBC, FFP and thrombocytes.…”

“…Repair of the valve (Alkhouli et al, 2019;Lee et al, 2021;Xie et al, 2023) or minimally invasive access (Kofler et al, 2021) was leading to lower transfusion rates. Patients who underwent surgical treatment of an infected tricuspid valve complicated by pulmonary embolism had a higher need for transfusion, compared to medically treated patients.…”

“…There was also only one report on the specific effect of gender in the need for transfusion (Friedrich et al, 2022). In only two series, the effect of CPB and cross-clamp time was investigated, but only with respect to surgical technique (Xie et al, 2023) or to gender. Women had more need for transfusion during surgery (Huang et al, 2019;Friedrich et al, 2022), for men this was after surgery (Friedrich et al, 2022).…”

“…Active IE was also one of the predictors for transfusion need (Huang et al, 2019). Anemia (Kofler et al, 2021;Lee et al, 2021;Friedrich et al, 2022) and coagulopathy (Lee et al, 2021;Xie et al, 2023;Kofler et al, 2021;Friedrich et al, 2022) were not investigated in several series. In the remaining surgical series, no clear picture could be seen: anemia was borderline higher (Alkhouli et al, 2019) or comparable (Xie et al, 2023) in the repair groups, but lower in the surgical group v. medical group (Siddiqui et al, 2022).…”

“…Anemia (Kofler et al, 2021;Lee et al, 2021;Friedrich et al, 2022) and coagulopathy (Lee et al, 2021;Xie et al, 2023;Kofler et al, 2021;Friedrich et al, 2022) were not investigated in several series. In the remaining surgical series, no clear picture could be seen: anemia was borderline higher (Alkhouli et al, 2019) or comparable (Xie et al, 2023) in the repair groups, but lower in the surgical group v. medical group (Siddiqui et al, 2022). Coagulopathy was higher in de surgical v. the medical group (Siddiqui et al, 2022), but lower in the repair v. the replacement group (Alkhouli et al, 2019;).…”