Optimum surgical treatment for tricuspid valve infective endocarditis: An analysis of the Society of Thoracic Surgeons national database

Objective: The incidence of intravenous drug-associated tricuspid valve endocarditis in the United States is rapidly increasing. Our goal was to evaluate the outcomes of isolated tricuspid valve operations using the Society of Thoracic Surgeon Adult Cardiac Surgical Database. Methods: From July 2011 to December 2016, 1613 patients with intravenous drug-associated tricuspid valve endocarditis underwent isolated tricuspid valve operations for endocarditis. Patients were stratified on the basis of type of tricuspid valve operation: valvectomy in 119 (7%), repair in 532 (33%), and replacement in 962 (60%). Risk factors and 30-day outcomes were compared among groups using Kruskal-Wallis and Pearson's chi-square tests. Multivariable logistic regression evaluated risk-adjusted operative mortality and morbidity by operative technique. Results: Age, gender, race, and renal function were comparable among groups. Compared with the repair and replacement groups, the valvectomy group had a higher rate of acute infection (90% vs 79%, 84%; P < .01), Model for End-Stage Liver Disease score (10.17 vs 8.44, 9.74, P < .01), and urgent/emergency surgery (91% vs 75%, 83%; P<.01), respectively. Operative mortality was higher in those undergoing valvectomy (16%) (P<.01) compared with repair (2%) or replacement (3%). After risk adjustment, valvectomy was associated with a higher risk of operative mortality compared with repair (odds ratio, 3.82; P < .01), whereas there was no difference in operative mortality between repair and replacement (odds ratio, 0.95; P = .89). Conclusions: This contemporary series of intravenous drug-associated tricuspid valve endocarditis reveals that valvectomy is an independent predictor of operative mortality. When anatomically possible, repair should be the preferred management for tricuspid valve endocarditis to avoid recurrent valve infection and prosthetic valve degeneration.

Automated summary

The study revealed that valvectomy for intravenous drug-associated tricuspid valve endocarditis is associated with higher acute infection rates, urgent surgery, and increased operative mortality compared to repair and replacement procedures. After risk adjustment, valvectomy was significantly associated with higher operative mortality compared to repair, while there was no significant difference in mortality between repair and replacement surgeries.