Tricuspid Valve Surgery in Patients with Isolated Tricuspid Valve Endocarditis: Analysis of Perioperative Parameters and Long-Term Outcomes.
BackgroundThe aim of this study was to evaluate the perioperative characteristics and the short- and mid-term outcomes in patients undergoing tricuspid valve (TV) surgery for isolated TV endocarditis.Patients and MethodsA total of 56 patients with isolated TV endocarditis underwent TV surgery at a single center between June 1995 and February 2012. Mean age of patients was 53.8 ± 17.1 years, 39 (69.6%) being male. The mean left ventricular ejection fraction was 60.4 ± 13.6% and 13 (23.2%) patients had diabetes mellitus. Average logistic EuroSCORE was 19.4 ± 17.0%. Mean follow-up was 4.7 ± 3.8 years.ResultsMicrobiological investigations revealed positive blood cultures in 89.1% of patients and positive intraoperative swabs in 51.9%. The most common pathogen (42.9%) isolated wasStaphylococcus aureus, followed by coagulase-negative staphylococcus (17.9%).DiscussionA history of intravenous drug abuse (IVDA) was recorded in 11 patients (19.6%), of which 8 patients additionally had hepatitis C. A total of 15 patients (26.8%) had a permanent pacemaker/implantable cardioverter-defibrillator in situ. TV replacement was performed in 22 patients (39.3%) and TV repair was performed in 34 patients (60.7%). Overall 30-day mortality was 12.5%. Five-year survival was 63.9 ± 7.2% (95% confidence interval [CI]: 64.0-137.5 months). Freedom from reoperation for recurrent TV endocarditis was 91.7 ± 4.0% (95% CI: 152.3-179.3 months) at 5 years.ConclusionBlood culture is the most important tool to detect the causative pathogen causing IE of TV. The high risk of hepatitis C in patients with IVDA and IE of the TV should be mentioned.
Department of Heart Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
Bettina
B
Pfannmueller
Department of Heart Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
Mareike
M
Kahmann
Department of Heart Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
Piroze
P
Davierwala
Department of Heart Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
Martin
M
Misfeld
Department of Heart Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
Farhad
F
Bakhtiary
Department of Heart Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
Christian
C
Binner
Department of Heart Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
Christian
C
Etz
Department of Heart Surgery, Leipzig Heart Centre, University of Leipzig, Leipzig, Germany.
Friedrich Wilhelm
FW
Mohr
D000328:Adult; D000368:Aged; D018572:Disease-Free Survival; D004697:Endocarditis, Bacterial / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D005260:Female; D005858:Germany; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects; D006526:Hepatitis C / Q000150:complications; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D012008:Recurrence; D012086:Reoperation; D012189:Retrospective Studies; D012307:Risk Factors; D013318:Stroke Volume; D015819:Substance Abuse, Intravenous / Q000150:complications; D013997:Time Factors; D016896:Treatment Outcome; D014261:Tricuspid Valve / Q000000981:diagnostic imaging / Q000382:microbiology / Q000503:physiopathology / Q000601:surgery*; D016277:Ventricular Function, Left