title: Current outcomes for tricuspid valve infective endocarditis surgery in North America.
abstract: BACKGROUND
  Tricuspid valve (TV) infective endocarditis (IE) accounts for 15% of IE cases and usually is treated medically. Surgical intervention is rare, and understanding of treatment options is based on small series of patients. The purpose of this study was to describe the population and outcomes for isolated TV IE using The Society of Thoracic Surgeons Adult Cardiac Database.
  
  
  METHODS
  Between 2002 and 2009, 910 operations for TV IE were performed. Procedures included replacement, repair, and valvectomy. Healed IE was present in 31.4% (n = 286), and active IE, in 68.5% (n = 624). Baseline patient characteristics as well as operative mortality and morbidity were analyzed, and univariate statistical differences were evaluated by Kruskal-Wallis test and stratum-adjusted Mantel-Haenszel χ(2) tests.
  
  
  RESULTS
  The median age was 40 years, with 50.6% male. Replacement of the TV was the most common procedure (n = 490; 53.8%), followed by TV repair (n = 354; 38.9%) and valvectomy (n = 66; 7.2%). Overall operative mortality was 7.3%, with no significant difference in mortality among valvectomy 12%, repair 7.6%, and replacement 6.3% (p = 0.34). Compared with the active group, healed patients experienced a trend toward lower operative mortality (4.2% versus 8.6%; p = 0.06), lower complication rates (35.6% versus 51.4%; p = 0.0004), and shorter overall length of stay (12 versus 22 days; p < 0.0001).
  
  
  CONCLUSIONS
  Isolated TV operation for IE is a rare clinical entity with a similar operative mortality to left-sided IE operations. Repair and replacement of the TV had similar perioperative mortality. Patients in the healed TV IE group demonstrated lower complication rates, length of stay, and a trend toward decreased mortality.
authors: Duke University Medical Center, Durham, North Carolina. Electronic address: jeffrey.gaca@duke.edu.
authors: Jeffrey G
authors: JG
authors: Gaca
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: Shubin
authors: S
authors: Sheng
authors: Duke University Medical Center, Durham, North Carolina.
authors: Mani
authors: M
authors: Daneshmand
authors: Vanderbilt University, Nashville, Tennessee.
authors: J Scott
authors: JS
authors: Rankin
authors: University of Louisville, Louisville, Kentucky.
authors: Matthew L
authors: ML
authors: Williams
authors: Duke Clinical Research Institute, Durham, North Carolina.
authors: Sean M
authors: SM
authors: O'Brien
authors: University of Maryland School of Medicine, Baltimore, Maryland.
authors: James S
authors: JS
authors: Gammie
mesh_terms: D000328:Adult; D004697:Endocarditis, Bacterial / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009656:North America; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000601:surgery*
keywords: 35