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Thorac Cardiovasc Surg 2017; 65(08): 634-638
DOI: 10.1055/s-0037-1606386
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Predictors of Surgical Outcome in Isolated Tricuspid Valve Endocarditis: Single Center Experience of 60 Patients

Mahmoud Singer
1   Department of Cardiothoracic Surgery, Cairo University, Cairo, Almaneal, Egypt
,
Hesham Alkady
1   Department of Cardiothoracic Surgery, Cairo University, Cairo, Almaneal, Egypt
,
Tarek Mohsen
1   Department of Cardiothoracic Surgery, Cairo University, Cairo, Almaneal, Egypt
,
Amr Roushdy
1   Department of Cardiothoracic Surgery, Cairo University, Cairo, Almaneal, Egypt
,
Alsayed Kamel Akl
1   Department of Cardiothoracic Surgery, Cairo University, Cairo, Almaneal, Egypt
,
Marwa Mashaal
2   Department of Cardiology, Cairo University, Cairo, Almaneal, Egypt
› Author Affiliations
Further Information

Publication History

29 June 2017

31 July 2017

Publication Date:
18 September 2017 (online)

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Abstract

Background Tricuspid valve (TV) endocarditis may be associated with serious complications, and 25% of patients require surgical intervention. However, indications and outcomes of surgery are not clearly identified. In this study, 60 patients are retrospectively reviewed to determine preoperative predictors of surgical outcome.

Patients and Methods Sixty patients with isolated TV endocarditis who underwent surgery in the period between January 2012 and December 2016 are reviewed retrospectively from the medical records of Cairo University Hospitals. Forty-two (70%) patients were males, and 18 (30%) were females with a mean age of 29.3 ± 10.6 years. Eleven patients had an underlying cardiac lesion, and 27 patients were intravenous (IV)-drug addicts.

Results TV repair could be done in nine (15%) patients, and the rest received TV replacement with biological valves. Twenty-four (40%) patients experienced postoperative complications. On multivariate analysis, a vegetation size >2.2 cm was a significant preoperative predictor for embolic complications and prolonged ventilation. In-hospital mortality occurred in 10 (16.67%) patients. Significant preoperative predictors of mortality were pulmonary embolization, congestive heart failure (HF), and the presence of pericardial effusion. During a mean follow-up period of 25 ± 12.6 months with echocardiography, two (4%) IV drug user patients developed recurrence of infection and needed reoperation.

Conclusion Surgery for tricuspid valve endocarditis (TVE) can be performed with good early and mid-term results. A large size of vegetations >2.2 cm is a significant risk factor for embolic complications. Preoperative predictors of in-hospital mortality according to our study are pulmonary embolization, congestive heart failure, and pericardial effusion.

Keywords

right-sided infective endocarditis - tricuspid valve endocarditis - predictors of surgical outcomes
 

  • References

  • 1 Habib G, Lancellotti P, Antunes MJ. , et al; Document Reviewers. 2015 ESC Guidelines for the management of infective endocarditis. Eur Heart J 2015; 36 (44) 3075-3128
    CrossrefPubMedGoogle Scholar
  • 2 Murdoch DR, Corey GR, Hoen B. , et al; International Collaboration on Endocarditis-Prospective Cohort Study (ICE-PCS) Investigators. Clinical presentation, etiology, and outcome of infective endocarditis in the 21st century: the International Collaboration on Endocarditis-Prospective Cohort Study. Arch Intern Med 2009; 169 (05) 463-473
    CrossrefPubMedGoogle Scholar
  • 3 Mathew J, Addai T, Anand A, Morrobel A, Maheshwari P, Freels S. Clinical features, site of involvement, bacteriologic findings, and outcome of infective endocarditis in intravenous drug users. Arch Intern Med 1995; 155 (15) 1641-1648
    CrossrefPubMedGoogle Scholar
  • 4 Morokuma H, Minato N, Kamohara K, Minematsu N. Three surgical cases of isolated tricuspid valve infective endocarditis. Ann Thorac Cardiovasc Surg 2010; 16 (02) 134-138
    PubMedGoogle Scholar
  • 5 Gammie JS. Invited commentary. An outstanding series of tricuspid valve operations for infective endocarditis. Ann Thorac Surg 2007; 84 (06) 1949
    CrossrefPubMedGoogle Scholar
  • 6 Akinosoglou K, Apostolakis E, Koutsogiannis N, Leivaditis V, Gogos CA. Right-sided infective endocarditis: surgical management. Eur J Cardiothorac Surg 2012; 42 (03) 470-479
    CrossrefPubMedGoogle Scholar
  • 7 Head SJ, Mokhles MM, Osnabrugge RL, Bogers AJ, Kappetein AP. Surgery in current therapy for infective endocarditis. Vasc Health Risk Manag 2011; 7: 255-263
    PubMedGoogle Scholar
  • 8 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
    CrossrefPubMedGoogle Scholar
  • 9 Moss R, Munt B. Injection drug use and right sided endocarditis. Heart 2003; 89 (05) 577-581
    CrossrefPubMedGoogle Scholar
  • 10 Singh SK, Tang GH, Maganti MD. , et al. Midterm outcomes of tricuspid valve repair versus replacement for organic tricuspid disease. Ann Thorac Surg 2006; 82 (05) 1735-1741 , discussion 1741
    CrossrefPubMedGoogle Scholar
  • 11 Musci M, Siniawski H, Pasic M. , et al. Surgical treatment of right-sided active infective endocarditis with or without involvement of the left heart: 20-year single center experience. Eur J Cardiothorac Surg 2007; 32 (01) 118-125
    CrossrefPubMedGoogle Scholar
  • 12 Durack DT, Lukes AS, Bright DK. ; Duke Endocarditis Service. New criteria for diagnosis of infective endocarditis: utilization of specific echocardiographic findings. Am J Med 1994; 96 (03) 200-209
    Google Scholar
  • 13 Sagristà-Sauleda J, Mercé AS, Soler-Soler J. Diagnosis and management of pericardial effusion. World J Cardiol 2011; 3 (05) 135-143
    CrossrefPubMedGoogle Scholar
  • 14 Morris AJ, Drinković D, Pottumarthy S, MacCulloch D, Kerr AR, West T. Bacteriological outcome after valve surgery for active infective endocarditis: implications for duration of treatment after surgery. Clin Infect Dis 2005; 41 (02) 187-194
    CrossrefPubMedGoogle Scholar
  • 15 Maragiannis D, Aggeli C, Nagueh SF. Echocardiographic evaluation of tricuspid prosthetic valves: an update. Hellenic J Cardiol 2016; 57 (03) 145-151
    PubMedGoogle Scholar
  • 16 Lee MR, Chang SA, Choi SH. , et al. Clinical features of right-sided infective endocarditis occurring in non-drug users. J Korean Med Sci 2014; 29 (06) 776-781
    CrossrefPubMedGoogle Scholar
  • 17 Ortiz C, López J, García H. , et al. Clinical classification and prognosis of isolated right-sided infective endocarditis. Medicine (Baltimore) 2014; 93 (27) e137
    CrossrefPubMedGoogle Scholar
  • 18 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
    CrossrefPubMedGoogle Scholar
  • 19 Dawood MY, Cheema FH, Ghoreishi M. , et al. Contemporary outcomes of operations for tricuspid valve infective endocarditis. Ann Thorac Surg 2015; 99 (02) 539-546
    CrossrefPubMedGoogle Scholar
  • 20 Tokunaga S, Masuda M, Shiose A, Tomita Y, Morita S, Tominaga R. Long-term results of isolated tricuspid valve replacement. Asian Cardiovasc Thorac Ann 2008; 16 (01) 25-28
    CrossrefPubMedGoogle Scholar
  • 21 Altaani HA, Jaber S. Tricuspid valve replacement, mechnical vs. biological valve, which is better?. Int Cardiovasc Res J 2013; 7 (02) 71-74
    PubMedGoogle Scholar
  • 22 Iscan ZH, Vural KM, Bahar I, Mavioglu L, Saritas A. What to expect after tricuspid valve replacement? Long-term results. Eur J Cardiothorac Surg 2007; 32 (02) 296-300
    CrossrefPubMedGoogle Scholar
  • 23 Kunadian B, Vijayalakshmi K, Balasubramanian S, Dunning J. Should the tricuspid valve be replaced with a mechanical or biological valve?. Interact Cardiovasc Thorac Surg 2007; 6 (04) 551-557
    CrossrefPubMedGoogle Scholar
  • 24 Vassileva CM, Shabosky J, Boley T, Markwell S, Hazelrigg S. Tricuspid valve surgery: the past 10 years from the Nationwide Inpatient Sample (NIS) database. J Thorac Cardiovasc Surg 2012; 143 (05) 1043-1049
    CrossrefPubMedGoogle Scholar
  • 25 Martín-Dávila P, Navas E, Fortún J. , et al. Analysis of mortality and risk factors associated with native valve endocarditis in drug users: the importance of vegetation size. Am Heart J 2005; 150 (05) 1099-1106
    CrossrefPubMedGoogle Scholar
  • 26 Carozza A, De Santo LS, Romano G. , et al. Infective endocarditis in intravenous drug abusers: patterns of presentation and long-term outcomes of surgical treatment. J Heart Valve Dis 2006; 15 (01) 125-131
    PubMedGoogle Scholar