Contemporary Outcomes of Operations for Tricuspid Valve Infective Endocarditis

Dawood, Murtaza Y.; Cheema, Faisal H.; Ghoreishi, Mehrdad; Foster, Nathaniel; Villanueva, Robert; Salenger, Rawn; Griffith, Bartley P.; Gammie, James S.

doi:10.1016/j.athoracsur.2014.08.069

Cited by 53 publications

(65 citation statements)

References 19 publications

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“…However, if valve replacement becomes necessary in TVIE, a bioprosthesis is preferable to a mechanical valve, which requires life-long anticoagulation in patients in whom IVDU is predominant and non-compliance is a major issue (1,3,7,17,(20)(21)(22). If a mechanical valve is implanted, access to the right ventricle for pacer leads and pulmonary catheters is also lost.…”

Section: Tricuspid Valve Replacementmentioning

confidence: 99%

“…Tricuspid valve surgery and conduction system injury Injury to the conduction system is a major concern with TV surgery, and the risk is greater in replacement vs. repair patients (3,7). TV replacement resulted in significantly more heart block (16%) than did repair (3%, P<0.0001) in 910 operations reported in North America for TVIE from the Society of Thoracic Surgeons database (3).…”

Section: Tricuspid Valve Excisionmentioning

confidence: 99%

“…Fortunately, TV repair can be accomplished in most cases, even those with extensive valve destruction, using a variety of techniques (7,17,(20)(21)(22). These include autologous pericardial patch augmentation of the destroyed leaflets, implantation of an annuloplasty ring and expanded polytetrafluoroethylene neo-chords, used as necessary.…”

Section: Tricuspid Valve Repairmentioning

confidence: 99%

“…Non-operative management of TVIE with antibiotics alone clears the bacteremia in 70-85% of cases and is associated with 7-11% in-hospital mortality. Between 5-16% of RSIE cases eventually require surgical intervention, with reported operative mortality between 0-15% for patients with isolated TVIE (1,3,5,7,9).…”

Section: Treatmentmentioning

confidence: 99%

“…Concomitant left-sided IE has its own indications (1) and carries a worse prognosis than right-sided infection alone (5), due predominantly to its greater likelihood for invasion and abscess formation (5,6). Overall mortality for RSIE is between 5-15% (1,7).…”

Section: Introductionmentioning

confidence: 99%

See 4 more Smart Citations

Tricuspid valve endocarditis

Hussain

Witten

Shrestha

et al. 2017

Ann. Cardiothorac. Surg.

103

124

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Right-sided infective endocarditis (RSIE) is less common than left-sided infective endocarditis (IE), encompassing only 5-10% of cases of IE. Ninety percent of RSIE involves the tricuspid valve (TV). Given the relatively small numbers of TVIE cases operated on at most institutions, the purpose of this review is to highlight and discuss the current understanding of IE involving the TV. RSIE and TVIE are strongly associated with intravenous drug use (IVDU), although pacemaker leads, defibrillator leads and vascular access for dialysis are also major risk factors. Staphylococcus aureus is the predominant causative organism in TVIE. Most patients with TVIE are successfully treated with antibiotics, however, 5-16% of RSIE cases eventually require surgical intervention. Indications and timing for surgery are less clear than for left-sided IE; surgery is primarily considered for failed medical therapy, large vegetations and septic pulmonary embolism, and less often for TV regurgitation and heart failure. Most patients with an infected prosthetic TV will require surgery. Concomitant left-sided IE has its own surgical indications. Earlier surgical intervention may potentially prevent further destruction of leaflet tissue and increase the likelihood of TV repair. Fortunately, TV debridement and repair can be accomplished in most cases, even those with extensive valve destruction, using a variety of techniques.Valve repair is advocated over replacement, particularly in IVDUs patients who are young, non-compliant and have a higher risk of recurrent infection and reoperation with valve replacement. Excising the valve without replacing, it is not advocated; it has been reported previously, but these patients are likely to be symptomatic, particularly in cases with septic pulmonary embolism and increased pulmonary vascular resistance. Patients with concomitant left-sided involvement have worse prognosis than those with RSIE alone, due predominantly to greater likelihood of invasion and abscess formation in left-sided IE. Patients with isolated TVIE have an operative mortality between 0-15% and excellent survival.

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