Midterm follow-up of tricuspid valve reconstruction due to active infective endocarditis

Background. Surgical methods for treatment of tricuspid valve (TV) endocarditis include complete TV excision, TV replacement, and the use of various reconstructive techniques even in cases of severe TV destruction and incompetence. This study summarizes our experience with TV reconstruction and replacement in patients with severe TV endocarditis. Methods. Between October 1997 and July 2004, TV reconstruction was performed in 18 patients (mean age, 38 +/- 17 years; 7 women, 11 men), and TV replacement in 4 patients (mean age, 48 +/- 22 years; 2 women, 2 men). All patients presented with active endocarditis and severe TV incompetence. Reconstructive techniques included debridement of vegetations, complete resection of infected or destroyed leaflet tissue, leaflet reconstruction with pericardial tissue, sliding plasty of residual valve tissue and bicuspid valve formation with construction of a new commissure, and consecutive ring annuloplasty in all patients. Results. There were no perioperative deaths. Late mortality was 0% for patients with TV reconstruction and 25% (n = 1) in the TV replacement group. At the latest follow-up (78% complete; mean, 53 +/- 18 months), 11 patients had no recurrent TV incompetence. Three patients presented with TV incompetence grade I or II. Two patients with TV reconstruction had recurrent TV endocarditis between 3 and 18 month postoperatively, including new vegetations in both patients and an additional pleural empyema in one. In all cases, conservative treatment was successful and no reoperation was required. Conclusions. The results of our study clearly demonstrate that in patients with severe TV endocarditis, complex reconstructive techniques yield excellent midterm results with regard to freedom of recurrence of endocarditis and valvular competence and should be considered as the primary surgical option in these patients. Tricuspid valve replacement should only be performed in cases of severe TV destruction that renders reconstructive techniques impossible.