Thorac Cardiovasc Surg 2014; 62 - OP120
DOI: 10.1055/s-0034-1367194

Tricuspid valve surgery in patients with isolated tricuspid valve endocarditis - Analyzation of perioperative parameters and long-term outcomes

B. Pfannmüller 1, M. Kahmann 1, C. Binner 1, P. Davierwala 1, M. Misfeld 1, J. Garbade 1, P. Dohmen 1, C. Etz 1, M.A. Borger 1, F.-W. Mohr 1
  • 1Herzzentrum Leipzig - Universitätsklinik, Leipzig, Germany

Objectives: The aim of this study was to analyze the perioperative parameters as well as the long-term outcomes of patients undergoing tricuspid valve (TV) surgery for isolated TV endocarditis.

Methods: A total of 56 patients with isolated TV endocarditis underwent TV surgery at the Leipzig Heart Center between June 1995 and February 2012. Of these, 39 patients (69.6%) were male, 21 patients (37.5%) suffered from renal failure, and 13 (23.2%) from diabetes mellitus. Mean age was 53.8 ± 17.1 years, mean left ventricular ejection fraction 60.4 ± 9.9% and average logEuroSCORE 19.4 ± 17%. Mean follow-up was 5.4 ± 3.9 years.

Results: Blood cultures and cultures of the TV tissue/ vegetations obtained at surgery were positive in 52 patients (92.9%) - with staphylococcus aureus in 24 (42.9%) patients and 10 patients (17.9%) having coagulase negative staphylococcus. Foreign bodies were the source of infection in 19 patients (33.9%), 15 (26.8%) of these being due to pacemaker leads. Intravenous drug abuse was observed as a cause in 11 patients (19.6%). TV replacement was performed in 23 patients (39.3%) and TV repair with annuloplasty in 13 patients (23.2%). Leaflet (vegetectomy and patch reconstruction) repair alone was performed in 21 patients (37.5%). Overall 30-day mortality was 12.7%. Five-year survival was 62.8% (95% confidence interval [CI] 5.3-11.5 years). The incidence for TV-related reoperations at 5 years was 7.5% (95% CI 6.4-8.7%) and was due to TV-reendocarditis in 4 out of 5 patients (two patients were intravenous drug-abusers, one had pacemaker-lead infection and one developed re-re TV prosthesis endocarditis with acute leukaemia as comorbidity).

Conclusions: TV surgery for TV endocarditis is often performed in patients with intravascular foreign bodies, intravenous drug abuse, and/or patients with weak immune system. Implantation of foreign material should be avoided in patients undergoing TV-surgery for TV endocarditis so as to reduce the risk of reendocarditis, especially in intravenous drug-abusers.