Tricuspid Valve Surgery in Patients with Isolated Tricuspid Valve Endocarditis: Analysis of Perioperative Parameters and Long-Term Outcomes
03 July 2015
27 August 2015
26 October 2015 (eFirst)
Background The aim of this study was to evaluate the perioperative characteristics and the short- and mid-term outcomes in patients undergoing tricuspid valve (TV) surgery for isolated TV endocarditis.
Patients and Methods A total of 56 patients with isolated TV endocarditis underwent TV surgery at a single center between June 1995 and February 2012. Mean age of patients was 53.8 ± 17.1 years, 39 (69.6%) being male. The mean left ventricular ejection fraction was 60.4 ± 13.6% and 13 (23.2%) patients had diabetes mellitus. Average logistic EuroSCORE was 19.4 ± 17.0%. Mean follow-up was 4.7 ± 3.8 years.
Results Microbiological investigations revealed positive blood cultures in 89.1% of patients and positive intraoperative swabs in 51.9%. The most common pathogen (42.9%) isolated was Staphylococcus aureus, followed by coagulase-negative staphylococcus (17.9%).
Discussion A history of intravenous drug abuse (IVDA) was recorded in 11 patients (19.6%), of which 8 patients additionally had hepatitis C. A total of 15 patients (26.8%) had a permanent pacemaker/implantable cardioverter-defibrillator in situ. TV replacement was performed in 22 patients (39.3%) and TV repair was performed in 34 patients (60.7%). Overall 30-day mortality was 12.5%. Five-year survival was 63.9 ± 7.2% (95% confidence interval [CI]: 64.0–137.5 months). Freedom from reoperation for recurrent TV endocarditis was 91.7 ± 4.0% (95% CI: 152.3–179.3 months) at 5 years.
Conclusion Blood culture is the most important tool to detect the causative pathogen causing IE of TV. The high risk of hepatitis C in patients with IVDA and IE of the TV should be mentioned.
* Both authors contributed equally to this work.
- 1 Habib G, Hoen B, Tornos P. , et al; ESC Committee for Practice Guidelines; Endorsed by the European Society of Clinical Microbiology and Infectious Diseases (ESCMID) and the International Society of Chemotherapy (ISC) for Infection and Cancer. Guidelines on the prevention, diagnosis, and treatment of infective endocarditis (new version 2009): the Task Force on the Prevention, Diagnosis, and Treatment of Infective Endocarditis of the European Society of Cardiology (ESC). Eur Heart J 2009; 30 (19) 2369-2413
- 2 Fehske W, Omran H, Manz M, Köhler J, Hagendorff A, Lüderitz B. Color-coded Doppler imaging of the vena contracta as a basis for quantification of pure mitral regurgitation. Am J Cardiol 1994; 73 (04) 268-274
- 3 Tribouilloy CM, Enriquez-Sarano M, Bailey KR, Tajik AJ, Seward JB. Quantification of tricuspid regurgitation by measuring the width of the vena contracta with Doppler color flow imaging: a clinical study. J Am Coll Cardiol 2000; 36 (02) 472-478
- 4 Kuntze T, Borger MA, Falk V. , et al. Early and mid-term results of mitral valve repair using premeasured Gore-Tex loops (‘loop technique’). Eur J Cardiothorac Surg 2008; 33 (04) 566-572
- 5 Seeburger J, Borger MA, Falk V. , et al. Minimal invasive mitral valve repair for mitral regurgitation: results of 1339 consecutive patients. Eur J Cardiothorac Surg 2008; 34 (04) 760-765
- 6 Mohr FW, Falk V, Diegeler A, Walther T, van Son JA, Autschbach R. Minimally invasive port-access mitral valve surgery. J Thorac Cardiovasc Surg 1998; 115 (03) 567-574 , discussion 574–576
- 7 Seeburger J, Borger MA, Passage J. , et al. Minimally invasive isolated tricuspid valve surgery. J Heart Valve Dis 2010; 19 (02) 189-192 , discussion 193
- 8 Yuan SM. Right-sided infective endocarditis: recent epidemiologic changes. Int J Clin Exp Med 2014; 7 (01) 199-218
- 9 Heydari AA, Safari H, Sarvghad MR. Isolated tricuspid valve endocarditis. Int J Infect Dis 2009; 13 (03) e109-e111
- 10 Baraki H, Saito S, Al Ahmad A. , et al. Surgical treatment for isolated tricuspid valve endocarditis- long-term follow-up at a single institution. Circ J 2013; 77 (08) 2032-2037
- 11 Capoun R, Thomas M, Caputo M, Asimakopoulos G. Surgical treatment of tricuspid valve endocarditis: a single-centre experience. Perfusion 2010; 25 (03) 169-173
- 12 Gottardi R, Bialy J, Devyatko E. , et al. Midterm follow-up of tricuspid valve reconstruction due to active infective endocarditis. Ann Thorac Surg 2007; 84 (06) 1943-1948
- 13 Jiang SL, Li BJ, Zhang T. , et al. Surgical treatment of isolated right-sided infective endocarditis. Tex Heart Inst J 2011; 38 (06) 639-642
- 14 Lange R, De Simone R, Bauernschmitt R, Tanzeem A, Schmidt C, Hagl S. Tricuspid valve reconstruction, a treatment option in acute endocarditis. Eur J Cardiothorac Surg 1996; 10 (05) 320-326
- 15 Gaca JG, Sheng S, Daneshmand M. , et al. Current outcomes for tricuspid valve infective endocarditis surgery in North America. Ann Thorac Surg 2013; 96 (04) 1374-1381
- 16 Revilla A, López J, Villacorta E. , et al. Isolated right-sided valvular endocarditis in non-intravenous drug users. Rev Esp Cardiol 2008; 61 (12) 1253-1259
- 17 Miró JM, Moreno A, Mestres CA. Infective endocarditis in intravenous drug abusers. Curr Infect Dis Rep 2003; 5 (04) 307-316
- 18 Stark K, Bienzle U, Vonk R. , et al. History of syringe sharing in prison and risk of hepatitis B virus, hepatitis C virus, and human immunodeficiency virus infection among injecting drug users in Berlin. Int J Epidemiol 1997; 26 (06) 1359-6619
- 19 Miró JM, del Río A, Mestres CA. Infective endocarditis and cardiac surgery in intravenous drug abusers and HIV-1 infected patients. Cardiol Clin 2003; 21 (02) 167-184 , v–vi
- 20 del Río A, Anguera I, Miró JM. , et al; Hospital Clínic Endocarditis Study Group. Surgical treatment of pacemaker and defibrillator lead endocarditis: the impact of electrode lead extraction on outcome. Chest 2003; 124 (04) 1451-1459
- 21 Chang BC, Lim SH, Yi G. , et al. Long-term clinical results of tricuspid valve replacement. Ann Thorac Surg 2006; 81 (04) 1317-1323 , discussion 1323–1324
- 22 Filsoufi F, Anyanwu AC, Salzberg SP, Frankel T, Cohn LH, Adams DH. Long-term outcomes of tricuspid valve replacement in the current era. Ann Thorac Surg 2005; 80 (03) 845-850
- 23 Kaplan M, Kut MS, Demirtas MM, Cimen S, Ozler A. Prosthetic replacement of tricuspid valve: bioprosthetic or mechanical. Ann Thorac Surg 2002; 73 (02) 467-473
- 24 Rankin JS, Hammill BG, Ferguson Jr TB. , et al. Determinants of operative mortality in valvular heart surgery. J Thorac Cardiovasc Surg 2006; 131 (03) 547-557
- 25 Arbulu A, Holmes RJ, Asfaw I. Tricuspid valvulectomy without replacement. Twenty years' experience. J Thorac Cardiovasc Surg 1991; 102 (06) 917-922
- 26 Hust MH, Metzler B, Ebermann F, Heinemann M, Ziemer G. Tricuspid valvulectomy in antibiotic-refractory right-heart endocarditis. Dtsch Med Wochenschr 1997; 122 (04) 80-85