Immediate tricuspid valve replacement for endocarditis. Indications and results

Area of Science:

• Cardiology
• Infectious Diseases
• Cardiac Surgery

Background:

• Tricuspid endocarditis is a serious infection often seen in intravenous drug users.
• Current recommendations include tricuspid valve excision to prevent reinfection, sepsis, and heart failure.
• Tricuspid valve excision may lead to significant hemodynamic compromise and heart failure in a substantial number of patients.

Purpose of the Study:

• To evaluate the efficacy and outcomes of tricuspid valve replacement versus excision in intravenous drug users with staphylococcal endocarditis.
• To determine if tricuspid valve replacement can prevent early and late reinfection, sepsis, and heart failure in this patient population.

Main Methods:

• A retrospective case series of 10 intravenous drug users with staphylococcal endocarditis who underwent tricuspid valve replacement after failing antibiotic therapy.
• Assessment of patient outcomes including infection resolution, heart failure development, and survival rates.

Main Results:

• All 10 patients treated with tricuspid valve replacement were discharged free of infection and heart failure.
• Two patients returned to physically demanding jobs without difficulty.
• Three patients who resumed intravenous drug abuse died from sepsis, but not necessarily from tricuspid reinfection.

Conclusions:

• Tricuspid valve replacement is a safe and effective treatment for tricuspid endocarditis in intravenous drug users.
• The practice of tricuspid valve excision for this condition is not necessary.
• Patient outcomes are significantly influenced by the cessation or continuation of intravenous drug abuse, irrespective of the surgical approach.