Surgical treatment of right-sided active infective endocarditis with or without involvement of the left heart: 20-year single center experience☆

Musci, M.; Siniawski, Henryk; Pašić, Miralem; Grauhan, O.; Weng, Yuguo; Meyer, Rudolf; Yankah, Charles; Hetzer, Roland

doi:10.1016/j.ejcts.2007.02.034

Cited by 104 publications

(102 citation statements)

References 23 publications

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“…It is assumed that there is a dynamic combination of host, environmental, immunological and microbial factors acting in concert to cause predominantly RSIE in this population, with specific factors contributing relatively more or less in any individual patient (10). Once the valve has been infected and damaged or replaced, repeated episodes of IE occur ever more frequently in IVDUs, with reinfection of up to 28% (5). One study reported a long-term cumulative incidence of reoperation of 20% in IVDU, as opposed to less than 5% in non-users (9).…”

Section: Intravenous Drug Usersmentioning

confidence: 99%

“…Higher priority of surgery (emergency vs. urgent vs. elective) could be pointed to as an independent risk factor for early mortality as well (5).…”

Section: Post-operative Outcomesmentioning

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%

“…Continuing IVDU is a significant risk factor for IE recurrence and death. S. aureus infection is another independent predictor of poor outcomes (1,5,22), as is hemodialysis (15), valve replacement (vs. repair) (7), vegetation >20 mm, fungal etiology and HIV infection with a CD4 count below 200 cells/µL (1).…”

Section: Post-operative Outcomesmentioning

confidence: 99%

“…Most patients with TVIE are successfully treated with antibiotics, and surgery is primarily considered only for large vegetations, recurrent septic pulmonary emboli, failure of medical therapy and infected prosthetic valves, and less often for severe tricuspid regurgitation (TR) and heart failure. 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%

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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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Section: Intravenous Drug Usersmentioning

confidence: 99%

“…Higher priority of surgery (emergency vs. urgent vs. elective) could be pointed to as an independent risk factor for early mortality as well (5).…”

Section: Post-operative Outcomesmentioning

confidence: 99%