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

Taylor Pickering; John Eisenga; Kyle McCullough; Ghadi Moubarak; Cody Dorton; Radhika Vaishnav; Lee Hafen; Justin Schaffer; Katherine Harrington; Robert Smith; Timothy George; William Brinkman; Kelley Hutcheson; Molly Szerlip; Sameh Sayfo; Srinivasa Potluri; Karim Al-Azizi; Michael J. Mack; J. Michael DiMaio

doi:10.36923/jhvd.v29i1.241

Open Access Article

Taylor Pickering⁽¹⁾ , John Eisenga⁽²⁾ , Kyle McCullough⁽³⁾ , Ghadi Moubarak⁽⁴⁾ , Cody Dorton⁽⁵⁾ , Radhika Vaishnav⁽⁶⁾ , Lee Hafen⁽⁷⁾ , Justin Schaffer⁽⁸⁾ , Katherine Harrington⁽⁹⁾ , Robert Smith⁽¹⁰⁾ , Timothy George⁽¹¹⁾ , William Brinkman⁽¹²⁾ , Kelley Hutcheson⁽¹³⁾ , Molly Szerlip⁽¹⁴⁾ , Sameh Sayfo⁽¹⁵⁾ , Srinivasa Potluri⁽¹⁶⁾ , Karim Al-Azizi⁽¹⁷⁾ , Michael J. Mack⁽¹⁸⁾ , J. Michael DiMaio⁽¹⁹⁾

(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

https://doi.org/10.36923/jhvd.v29i1.241

Issue
Vol. 29 No. 1 (2024)

Submitted
August 13, 2024

Published
October 20, 2024

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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,

Keywords:

Tricuspid valve endocarditis, Percutaneous mechanical aspiration, Medical management, Surgical intervention, Tricuspid regurgitation, Multidisciplinary approach

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Authors

Taylor Pickering

Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA

https://orcid.org/0009-0001-6369-3807

taylor.pickering91@gmail.com (Primary Contact)

John Eisenga

Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA

https://orcid.org/0000-0003-0950-8620

Kyle McCullough

Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA

https://orcid.org/0000-0001-8984-4354

Ghadi Moubarak

Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA

https://orcid.org/0009-0002-9280-5238

Cody Dorton

Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA

https://orcid.org/0009-0003-5789-2986

Radhika Vaishnav

Baylor Scott & White Research Institute, The Heart Hospital Plano, Texas, USA

https://orcid.org/0000-0001-6398-2644

Lee Hafen