Surgical treatment of intractable right-sided infective endocarditis in drug addicts: 25 years experience.
During the past 25 years the authors have performed the following operations in the surgical treatment of intractable right-sided endocarditis in drug addicted patients: 1) Excision of the infected tricuspid valve and replacement with a mechanical or bioprosthetic valve during the same operation. In these patients the overall mortality was 100% due to: (a) inability to control the endocarditis in 80%; (b) re-infection due to a return to drug abuse and (c) fatal complications due to non-compliance with anticoagulant therapy. 2) Tricuspid valvulectomy in 53 patients, tricuspid and pulmonary valvulectomy without replacement in two patients. Six patients (11%) died within six weeks. Five due to the endocarditis and one due to low cardiac output. Ten patients (18%) died six months to 13 years later. In nine of these patients, death was related to continued drug abuse. At 22 years the actuarial survival is 64%. This experience supports the authors conclusion that among drug addicts with intractable right-sided endocarditis, tricuspid valvulectomy or tricuspid and pulmonary valvulectomy without replacement is/are the operation(s) of choice.
Arbulu
A
A
Wayne State University School of Medicine, Detroit.
Holmes
R J
RJ
Asfaw
I
I
D000328:Adult; D002177:Candidiasis / Q000601:surgery; D002423:Cause of Death; D004696:Endocarditis / Q000382:microbiology / Q000601:surgery; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005260:Female; D006349:Heart Valve Diseases / Q000601:surgery; D006350:Heart Valve Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D011552:Pseudomonas Infections / Q000601:surgery; D011550:Pseudomonas aeruginosa; D011664:Pulmonary Valve / Q000601:surgery; D012008:Recurrence; D012086:Reoperation; D015819:Substance Abuse, Intravenous; D015996:Survival Rate; D013997:Time Factors; D014261:Tricuspid Valve / Q000601:surgery*