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Avoiding the pump in tricuspid valve endocarditis--vegetectomy under inflow occlusion
Jai Raman1, Rinaldo Bellomo, Pallav Shah
1Department of Cardiac Surgery and Intensive Care, Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, Australia.
Summary
Tricuspid valve vegetectomy without cardiopulmonary bypass (CPB) using vena caval inflow occlusion (VCIO) is safe and effective. Postoperative high volume veno-venous hemofiltration (HVVF) aids recovery from sepsis and inflammation.
Area of Science:
- Cardiovascular Surgery
- Infectious Diseases
- Critical Care Medicine
Background:
- Tricuspid valve endocarditis (TVE) surgical options include vegetectomy or valve replacement, often requiring cardiopulmonary bypass (CPB).
- CPB carries risks of systemic and pulmonary complications.
- This study explores tricuspid valve vegetectomy performed without CPB, utilizing vena caval inflow occlusion (VCIO).
Purpose of the Study:
- To evaluate the safety and efficacy of tricuspid valve vegetectomy under VCIO.
- To assess the role of high volume veno-venous hemofiltration (HVVF) in postoperative recovery.
Main Methods:
- Seven patients with TVE underwent tricuspid valve vegetectomy under VCIO between 1998 and 2001.
- Indications included recurrent septic pulmonary emboli and intractable sepsis with large vegetations (>1 cm).
- Five patients received postoperative HVVF.
Main Results:
- No deaths occurred; VCIO time was minimal (≤2 minutes).
- All patients showed sepsis resolution and improved respiratory status within 48 hours.
- Six patients were discharged within 14 days; one required dialysis, and another needed empyema drainage.
Conclusions:
- Tricuspid valve vegetectomy can be safely performed using VCIO.
- HVVF appears to promote recovery by removing inflammatory mediators.