Tricuspid valvulectomy without replacement. Twenty years' experience.
Since September 1970, we have operated on 55 patients with intractable right-sided endocarditis. All patients were addicted to heroin. Fifty-three underwent tricuspid valvulectomy without replacement and in addition two had pulmonic valve excision. Twenty-four patients (49%) returned to their drug addiction. Six patients (11%) required prosthetic heart valve insertion 2 days to 13 years later for medically refractory right-sided heart failure, and four of these died. Overall, 16 patients (29%) died, six (11%) within 45 days after the tricuspid valvulectomy. One (2%) of these deaths was related to the operation and five were due to uncontrollable infection. Ten (18%) deaths occurred 9 months to 13 years after the tricuspid valvulectomy. Nine were due to drug addiction and one to progressive right ventricular failure 2 months after prosthetic heart valve insertion and 10 years after the initial valve removal. Of the 39 patients who are alive, 37 (67%) have not required prosthetic heart valve insertion. From our observations we reached the following conclusions: (1) Drug addiction is a recurrent and lethal disease. Among these patients, tricuspid valvulectomy without replacement is the operation of choice for the management of intractable right-sided endocarditis; (2) after tricuspid valvulectomy without replacement, only six of 55 patients (11%) had required prosthetic heart valve insertion to control medically refractory right-sided heart failure; (3) in a small percentage of patients the absence of the tricuspid valve may lead to severe and permanent impairment of right ventricular function.
Arbulu
A
A
Wayne State University, School of Medicine, Detroit, Mich.
Holmes
R J
RJ
Asfaw
I
I
D000206:Actuarial Analysis; D000328:Adult; D004697:Endocarditis, Bacterial / Q000401:mortality / Q000601:surgery*; D005260:Female; D006350:Heart Valve Prosthesis; D006556:Heroin Dependence / Q000150:complications* / Q000401:mortality; D006801:Humans; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000401:mortality / Q000601:surgery*; D011550:Pseudomonas aeruginosa; D014261:Tricuspid Valve / Q000601:surgery*