Open Access Article October 20, 2024

9 Pages

Comparative Outcomes of Medical, Percutaneous, and Surgical Treatments for Tricuspid Valve Endocarditis

Authors

Taylor Pickering1,* , John Eisenga2 , Kyle McCullough3 , Ghadi Moubarak4 , Cody Dorton5 , Radhika Vaishnav6 , Lee Hafen7 , Justin Schaffer8 , Katherine Harrington9 , Robert Smith10 , Timothy George11 , William Brinkman12 , Kelley Hutcheson13 , Molly Szerlip14 , Sameh Sayfo15 , Srinivasa Potluri16 , Karim Al-Azizi17 , Michael J. Mack18 , J. Michael DiMaio19

  1. Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA
  2. Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA
  3. Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA
  4. Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA
  5. Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA
  6. Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA
  7. Department of Cardiothoracic Surgery, Baylor Scott & White: The Heart Hospital Plano, Texas, USA.
  8. Department of Cardiothoracic Surgery, Baylor Scott & White: The Heart Hospital Plano, Texas, USA.
  9. Department of Cardiothoracic Surgery, Baylor Scott & White: The Heart Hospital Plano, Texas, USA.
  10. Department of Cardiothoracic Surgery, Baylor Scott & White: The Heart Hospital Plano, Texas, USA.
  11. Department of Cardiothoracic Surgery, Baylor Scott & White: The Heart Hospital Plano, Texas, USA.
  12. Department of Cardiothoracic Surgery, Baylor Scott & White: The Heart Hospital Plano, Texas, USA.
  13. Department of Cardiothoracic Surgery, Baylor Scott & White: The Heart Hospital Plano, Texas, USA.
  14. Department of Cardiology, Baylor Scott & White: The Heart Hospital Plano, Texas., USA
  15. Department of Cardiology, Baylor Scott & White: The Heart Hospital Plano, Texas., USA
  16. Department of Cardiology, Baylor Scott & White: The Heart Hospital Plano, Texas., USA
  17. Department of Cardiology, Baylor Scott & White: The Heart Hospital Plano, Texas., USA
  18. Texas A&M University, Department of Biomedical Engineering, USA
  19. Texas A&M University, Department of Biomedical Engineering, USA
  20. * Author to whom correspondence should be addressed.

Journal of Heart Valve Disease Innovation 2024, 29(1), 51-59; https://doi.org/10.36923/jhvd.v29i1.241

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Abstract

Background: Tricuspid valve endocarditis (TVE) remains a significant cause of morbidity and mortality worldwide. Given the considerable variation in presentation and severity, as well as ongoing advances in percutaneous and operative interventions, the optimal treatment strategy remains undetermined. This study aims to report the outcomes of medical management (MM), percutaneous mechanical aspiration (PMA), and surgical intervention in isolated TVE patients. Methods: We conducted a single-centre retrospective review of consecutive patients with isolated TVE from June 2020 to January 2023. Diagnosis was based on the modified Duke criteria and confirmed with echocardiographic findings. Patients were categorized based on the intervention received: MM, PMA, or surgical intervention. The type of intervention received was determined by the consensus agreement of a multidisciplinary high-risk heart team. Primary outcomes included 30-day and 1-year survival rates. Secondary outcomes included length of hospital stay, degree of residual tricuspid regurgitation, and complications including septic emboli, pleural effusion, and stroke. Results: Overall, 20 patients were treated for TVE: 7 received MM, 4 underwent PMA, and 9 underwent surgical intervention. The 30-day survival rates were 57.1% for MM, 100% for PMA, and 100% for surgery (p=0.038). One-year survival rates were 57.1% for MM, 100% for PMA, and 88.9% for surgery (p=0.155). PMA patients had the longest median hospital stay (14.5 days), followed by surgical (13.5 days) and MM (5 days) groups. Post-intervention echocardiography showed a significant reduction in tricuspid regurgitation severity in the surgical group but an increase in the PMA group. Complications including septic emboli, reoperation, heart block and pleural effusion were insignificant between groups. Conclusion: This study suggests that intervention, either PMA or surgery, may offer superior short-term survival benefits compared to MM in surgically fit patients presenting with isolated TVE. The findings highlight the need for a multidisciplinary approach in managing TVE and suggest further prospective studies are warranted to establish definitive treatment guidelines,

Article information

Keywords
Tricuspid valve endocarditisPercutaneous mechanical aspirationMedical managementSurgical interventionTricuspid regurgitationMultidisciplinary approach
Section
Articles
Issue
Vol. 29 No. 1 (2024)
Submitted
August 13, 2024
Accepted
October 13, 2024
Published
October 20, 2024
Corresponding author
Taylor Pickering
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