Surgical Valve Repair Following Infective Tricuspid Valve Endocarditis
Veronica Lorenz, Stefano Mastrobuoni, Yannick K. Kolela, Laurent de Kerchove, Gebrine El Khoury.
Clinique Universitaires Saint Luc, Bruxelles, Belgium.
OBJECTIVE: Although current guidelines recommend tricuspid valve repair for native tricuspid valve endocarditis (TVE), the percentages of valve replacement remain very high in numerous studies. The aim of our study is to analyse our experience in the treatment of TVE and in particular to evaluate the effectiveness of the reparative approach, focusing mainly on the use of patch technique.
METHODS: A total of 32 patients with the definite diagnosis of infective TVE underwent TV surgery between February 2001 and December 2020. Of these 87.5% (n=28) underwent TV repair and the 12.5 % had a TV replacement, 1 with bio-prosthesis and 3 with a mitral homograft. The repair group was divided into two subgroups according to whether (n=10) or not (n=18) a patch was used during surgery. The median follow-up was 78 and 119 months for repair and replacement groups respectively.
RESULTS: Hospital mortality was 25% for replacement group and 7.1% for repair (P = 0.25). Freedom from reoperation on the tricuspid valve at 5 and 10 years was 92.3% and 79% respectively. Overall survival at 5 and 10 years was 78% and 70% respectively. When the repair with or without patch groups were compared, hospital mortality was 10% and 5.6% (p=0.66); at 10 years freedom from TV reoperation was 58.3% (95% CI: 7.6-89%) and 93.3% (95% CI: 61- 99%) respectively (p=0.4). Only 2 patients in patch group had a recurrent episode of endocarditis.
CONCLUSIONS: Infective valve endocarditis still remains a serious life-threatening condition. Considering that TVE are more common in young patients, a repair-oriented approach should be regarded as the first choice. In case of extremely damaged valves the use of pericardial patch is an effective therapeutic procedure as the more simple repairs.
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