Surgical treatment of right-sided infective endocarditis

The Journal of Thoracic and Cardiovascular Surgery

James C. Witten¹  Syed T. Hussain²  Penny L. Houghtaling³  Nabin K. Shrestha⁴  Steven M. Gordon⁵ 

[1] Education Institute, Cleveland Clinic Lerner College of Medicine, Cleveland, Ohio;Heart and Vascular Institute, Department of Thoracic and Cardiovascular Surgery;Medicine Institute, Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio;Medicine Institute, Department of Infectious Disease;Research Institute, Department of Quantitative Health Sciences

关键词: infective endocarditis;    right-sided;    tricuspid valve;    pulmonary valve;    etiology;   

DOI  :  10.1016/j.jtcvs.2018.07.112

学科分类：心脏病和心血管学

来源: Mosby, Inc.

【 摘 要 】

ObjectiveRight-sided infective endocarditis is increasing because of increasing prevalence of predisposing conditions, and the role and outcomes of surgery are unclear. We therefore investigated the surgical outcomes for right-sided infective endocarditis.MethodsFrom January 2002 to January 2015, 134 adults underwent surgery for right-sided infective endocarditis. Patients were grouped according to predisposing condition. Hospital outcomes, time-related death, and reoperation for infective endocarditis were analyzed.ResultsA total of 127 patients (95%) had tricuspid valve and 7 patients (5%) pulmonary valve infective endocarditis; 66 patients (49%) had isolated right-sided infective endocarditis, and 68 patients (51%) had right- and left-sided infective endocarditis. Predisposing conditions included injection drug use (30%), cardiac implantable devices (26%), chronic vascular access (19%), and other/none (25%). One native tricuspid valve was excised, 76% were repaired or reconstructed, and 23% were replaced. Intensive care unit and postoperative hospital stays were similar among groups. Injection drug users had the best early survival (no hospital mortality), and patients with chronic vascular access had the worst late survival (18% at 5 years). Survival was worst for concomitant mitral valve versus isolated right-sided infective endocarditis or concomitant aortic valve infective endocarditis. Survival after tricuspid valve replacement was worse than after repair/reconstruction. Estimated glomerular filtration rate was the strongest risk factor for death, not predisposing condition. Eleven patients underwent 12 reoperations for infective endocarditis; more reoperations occurred in injection drug users (P = .03).ConclusionsOverall outcomes after surgery are variable and affected by patient condition, not predisposing condition. Injection drug use carries a higher risk of reoperation for infective endocarditis. Earlier surgery may permit more valve repairs and improve outcomes. Whenever possible, tricuspid valve replacement should be avoided.

【 授权许可】

Unknown