Outcomes of tricuspid valve repair versus replacement for the surgical treatment of infective endocarditis

Mohamed Laimoud; Ahmed Algamoum; Mohamed Fouly

Mohamed Laimoud Department of Cardiovascular Critical Care, King Faisal Hospital, Saudi Arabia
Ahmed Algamoum Cardiovascular Medicine, King Faisal Hospital, Saudi Arabia
Mohamed Fouly Department of Cardiothoracic Surgery, Cairo University, Giza, Egypt

Keywords: Tricuspid valve, Infective endocarditis, Tricuspid valve replacement, Tricuspid valvuloplasty

Abstract

Background: The surgical management of right-sided infective endocarditis (IE) is challenging, and the superiority of tricuspid valvuloplasty (TVP) or tricuspid valve replacement (TVR) is not well established. Our study aimed to compare the clinical outcomes of TVP and TVR for right-sided IE.

Methods: All patients aged ≥18 years with isolated right-sided IE who underwent surgical treatment between 2015 and 2022 were retrospectively studied. The enrolled patients were diagnosed according to the modified Duke criteria and had tricuspid valve vegetation. The primary outcome was 6-month mortality, and the secondary outcomes included recurrence of IE, recurrence of tricuspid regurgitation (TR), need for reoperation, new need for dialysis, need for a permanent pacemaker, cerebrovascular stroke, and duration of ICU stay.

Results: 109 adult patients with isolated tricuspid valve infective endocarditis underwent surgical treatment. Sixty (55%) patients had TVP, and 49 (45%) had TVR. The patients who underwent TVR were significantly younger [54 (48-56) vs. 47 (39-52) years, p<0.001] and had greater frequencies of staphylococcal and fungal infections than the patients who underwent TVP. Compared with the TVP group, the TVR group had significantly longer cardiopulmonary bypass [79 (76-87) vs. 98 (95-108) min, p<0.001) and aortic cross-clamping times [51 (45-56) vs. 75 (72-80) min, p<0.001]. Patients with TVP had lower rates of recurrent IE (8.3% vs. 32.7%, p=0.02), recurrent TR (11.7% vs. 32.7%, p=0.023), reoperation (11.7% vs. 32.7%, p=0.023) and 6-month mortality (3.33% vs. 14.29%, p=0.06) than did those in the TVR group. There were no significant differences in blood loss, reopening for bleeding, new need for dialysis, cerebrovascular stroke or ICU stay between the two groups.

Conclusions: Compared with tricuspid valve replacement, tricuspid valve repair might be associated with lower rates of recurrent IE and reoperation. Although statistically insignificant, tricuspid valve replacement was associated with a greater mortality rate than TV repair. TVP could be the recommended treatment for patients with right-sided IE.