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DOI: 10.1055/s-0032-1332444
Long-term follow-up after surgical treatment of isolated tricuspid valve endocarditis
Objective: Acute tricuspid valve (TV) endocarditis is associated with high morbidity and mortality, but long-term data of these patients are limited. The aim of this study was to investigate the outcome of patients that underwent surgery for isolated TV endocarditis.
Methods: Between 6/1996 and 12/2011, we retrospectively investigated 637 patients who underwent TV surgery in our institution. Out of the 637 patients, 29 patients (13 female, mean age 49 ± 22 years) underwent isolated TV surgery for endocarditis: Biological TV replacement (n = 12), mechanical TV replacement (n = 4) and TV reconstruction (n = 13). A total of 24 cases (82%) were associated with intravenous drug abuse (n = 12) or pacemaker infection (n = 12). Patients underwent follow-up echocardiography and long-term data analysis.
Results: Mean follow-up was 5.4 ± 4.1 years (81% completed). Survival at 1, 5 and 10 years were 86%, 70% and 70%, respectively. The 30-day mortality was 10%. Out of 26 survivors, 4 died during follow-up and 2 required TV reoperation. Freedom from reoperation was 100%, 92% and 77%, respectively.
During follow-up the mean NYHA class improved significantly (2.5 ± 0.7 versus 2.0 ± 0.8, p = 0.04), and echocardiography revealed regular findings in all patients after valve replacement. Two patients presented with a remaining TV insufficiency grade II after TV reconstruction. Statistical analysis identified age, redo surgery, renal impairment, right heart insufficiency, reduced left heart function and logistic EuroSCORE as risk factors for 30-day mortality. Age, logistic EuroSCORE and beating heart procedures proved to be risk factors for long-term mortality.
Conclusions: Isolated TV surgery is strongly associated with intravenous drug abuse or pacemaker leads. Long-term outcome is acceptable without differences between the surgical procedures. Beating heart surgery did not improve outcome.