Right-sided infective endocarditis: valvuloplasty, valvectomy or replacement.

Area of Science:

• Cardiology
• Cardiac Surgery
• Infectious Diseases

Background:

• Right-sided infective endocarditis (IE) poses significant challenges, often requiring surgical intervention after medical treatment failure.
• Prosthetic valve replacement carries risks, making valve-sparing reconstruction a desirable alternative.

Purpose of the Study:

• To evaluate the efficacy and outcomes of surgical reconstruction for right-sided infective endocarditis.
• To compare the results of valve reconstruction, valvectomy, and prosthetic valve replacement in this patient cohort.

Main Methods:

• Retrospective analysis of 15 patients undergoing surgery for right-sided IE.
• Surgical strategies included valve reconstruction, isolated valvectomy, and prosthetic valve replacement.
• Outcomes assessed included hospital mortality, late recurrence, and need for reoperation.

Main Results:

• 60% (9/15) of patients underwent successful valve reconstruction without replacement.
• Four patients required prosthetic valve replacement due to extensive infection or residual regurgitation.
• Two patients underwent isolated valvectomy.
• Hospital mortality was 6.7% (1/15).
• No late recurrence or replacement occurred in the 9 reconstructed valves.
• 40% (2/5) of patients in the valvectomy and replacement groups experienced late replacement or death from infection.

Conclusions:

• Right-sided infective endocarditis is often amenable to valve reconstruction, achieving satisfactory hemodynamics without prosthetic material.
• Valve reconstruction demonstrates superior late outcomes compared to valvectomy or replacement.
• Isolated valvectomy is a viable option in select cases.
• Prosthetic valve replacement may be necessary for complex cases or associated left-sided infections.