Early And Mid-term Outcomes Of Surgical Treatment Of Tricuspid Valve Endocarditis In Patients With Intravenous Drug Abuse
Kenji Minakata, William Moser, Gengo Sunagawa, Mark Mitchell, Fatuma Kromah, Suresh Keshavamurthy, Jesus Gomez-Abraham, Yoshiya Toyoda.
Temple University, Philadelphia, PA, USA.
OBJECTIVE: Intravenous drug abuse (IVDA) is a nation-wide pandemic medical issue, which is associated with a number of clinical conditions including infective endocarditis (IE). Tricuspid valve (TV) is known to be commonly involved in this situation causing TVIE with a wide variety of presentations such as sepsis, pulmonary septic emboli, and/or heart failure. According to the current treatment guidelines, the indications for urgent surgical intervention include persistent infection, large vegetation, and right sided heart failure. Previous reviews reported in-hospital mortality rates ranged from 5 to 20%.
METHODS: Between 2012 and 2017, 20 patients underwent 22 open TV procedures in authors' services. The mean age of the patients was 33.7+6.7 years, and 10 were male. Two patients were found to have left sided IE as well. Six patients had prosthetic valve endocarditis (PVE). The microorganisms causing TVIE included MRSA in 11, MSSA in 7, Streptococcus in 3, and others in 2. Six patients were in septic shock. The mean interval between the surgical consult to the operation was 5.3 days.
RESULTS: TV repair was performed in 14 patients (88% in native TVIE), while TV replacement (all biological valve) was performed in 8 patients. 7 patients had previous median sternotomy up to 4 times. The repair techniques included patch reconstruction with chordal replacement in 12 and annuloplasty (suture in 6 and ring in 3) in 9. The mean aortic-cross-clamp time and the cardiopulmonary bypass time were 71+14 and 116+24 minutes, respectively. There was only one in-hospital death (4.5%). However, 2 patients required redo TV procedures a few months after the initial successful repair procedures due to recurrent TVIE related to IVDA. Also, there were 3 late deaths (17, 5, and 3 months after surgery) in which all the patients developed multiorgan failure due to recurrent infection related to recidivism of IVDA.
CONCLUSIONS: TV procedures in patients with active IE can be done with low in-hospital mortality, however recurrent infection due to recidivism of IVDA is common, and appears to impact the late survival.
Back to 2018 Program