Elsevier

The Annals of Thoracic Surgery

Volume 84, Issue 6, December 2007, Pages 1943-1948
The Annals of Thoracic Surgery

Original article
Cardiovascular
Midterm Follow-Up of Tricuspid Valve Reconstruction Due to Active Infective Endocarditis

https://doi.org/10.1016/j.athoracsur.2007.04.116Get rights and content

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.

Section snippets

Material and Methods

Between October 1997 and July 2004, 22 consecutive patients with active tricuspid valve endocarditis underwent surgical treatment at our institution. In 1997 we started to aggressively use reconstructive techniques rather than valve replacement in all patients presenting with active infective tricuspid valve endocarditis. The aim of this retrospective study was to analyze our results after tricuspid valve reconstruction for active infective tricuspid endocarditis during at least a midterm

Results

There was no intraoperative death. Mean follow-up was 53 ± 18 months and was 81% complete (n = 17). The remaining 4 patients (3 patients in the reconstruction group and 1 patient in the replacement group) were not available for follow-up. However, in 3 of those patients recent discharge reports from other hospitals because of admissions for other medical reasons were obtained that did not indicate any recurrence of endocarditis or other cardiac problems, and none of these patients was quoted in

Comment

The incidence of tricuspid valve endocarditis has risen during the last three decades [14, 15] for several reasons: (1) The number of people addicted to intravenous drug abuse that predisposes to tricuspid valve endocarditis is growing [16]. (2) Advances in interventional electrophysiology have prolonged the survival of patients with heart block or malignant tachyarrhythmia, and there is a concomitant use of implantable devices as pacemakers and defibrillators [17, 18]. (3) There is an increase

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