Tricuspid valve repair for infective endocarditis

Area of Science:

• Cardiology
• Cardiac Surgery
• Infectious Diseases

Background:

• Increasing use of implantable devices and vascular access contributes to right-sided infective endocarditis.
• Tricuspid valve endocarditis (TVE) is a growing concern, particularly in patients with congenital heart disease and those requiring dialysis.
• Current guidelines favor tricuspid valve repair, yet valve replacement remains frequent in practice.

Purpose of the Study:

• To analyze the clinical experience with a reparative approach for native tricuspid valve endocarditis (TVE).
• To evaluate the outcomes of tricuspid valve repair versus replacement in patients with TVE.
• To assess the long-term survival and reoperation rates following TVE treatment.

Main Methods:

• A case series of 31 patients who underwent surgery for acute or healed native tricuspid valve endocarditis (TVE) between 2001 and 2020.
• Patients were categorized based on surgical approach: tricuspid valve repair (n=28) or replacement (n=3).
• Subgroup analysis of repair outcomes based on the use of a pericardial patch.

Main Results:

• Tricuspid valve repair was performed in 90.3% of patients, with only 9.7% undergoing valve replacement.
• Hospital mortality was lower in the repair group (7.1%) compared to the replacement group (33.3%).
• Ten-year overall survival was 75.6%, with freedom from reoperation at 10 years being 59.3% for patch repair and 93.7% for non-patch repair. Freedom from recurrent endocarditis was 87% at 10 years.

Conclusions:

• A repair-oriented strategy should be the primary choice for tricuspid valve endocarditis (TVE), especially in younger patients.
• Pericardial patch use is a viable option for severely damaged valves.
• Mitral homograft replacement serves as a valuable alternative when repair is not feasible, minimizing prosthetic material use.