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Cardiothoracic Surgery |

Surgical Management of Tricuspid Valve Endocarditis in Systemically Infected Patients

Sharven Taghavi*, MD; Rachael Clark, BS; Senthil Jayarajan; John Gaughan, PhD; Stacey Brann, MD; Abeel Mangi, MD
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Temple University Hospital, Philadelphia, PA


Chest. 2012;142(4_MeetingAbstracts):76A. doi:10.1378/chest.1382725
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Abstract

SESSION TYPE: Cardiac Surgery Posters

PRESENTED ON: Wednesday, October 24, 2012 at 01:30 PM - 02:30 PM

PURPOSE: Isolated bacterial tricuspid valve (TV) endocarditis is usually managed medically. The indications and optimal timing for surgical intervention has not been clearly defined. We hypothesize that early surgical intervention in patients who are bacteremic and/or have evidence of systemic seeding is superior to medical treatment.

METHODS: All cases of isolated TV endocarditis from 2006-2011 were reviewed retrospectively and patients demonstrating bacteremia and/or systemic seeding were identified. Patients treated surgically after short-term medical therapy were compared to an equivalent group of patients who remained under long-term medical treatment only.

RESULTS: Forty-nine patients were hospitalized with isolated TV endocarditis over six years. Of these, 10 (20.4%) were treated surgically with tricuspid valve repair or replacement. Thirty-five of the patients receiving only medical therapy displayed evidence of bacteremia and/or systemic seeding. Thirty-day and one-year survival in both groups was comparable (100% vs. 88.6%, p=0.295). Patients treated surgically cleared blood cultures sooner (2.0 vs. 6.7 days, p=0.040), defervesced earlier (0 vs. 9.3 days, p=0.016), and demonstrated rapid and complete resolution of TV vegetations (0.0 vs. 75.0%, p<0.001). Change in creatinine clearance (+22.1 vs. +11.1 ml/min, p=0.397), length of vasopressor or ionotropic support (6.8 vs. 8.2 hours, p=0.863), duration of mechanical ventilation (8.5 vs. 29.7 hours, p=0.497), intensive care unit length of stay (159.1 vs. 49.6 hours, p=0.087) and total hospital length of stay (32.1 vs.24.6 days, p=0.224) were not significantly different between the two groups. Long-term echocardiogram surveillance demonstrated a higher prevalence of moderate to severe tricuspid regurgitation in the medically treated (75.0%, n=16) as compared to the surgically treated group (0.0%, n=10); p<0.001. No patient treated surgically was re-admitted with prosthetic valve endocarditis.

CONCLUSIONS: Early surgical therapy is warranted in a subset of patients with isolated tricuspid valve endocarditis. Patients who are bacteremic and systemically infected despite optimal medical therapy may benefit from early surgery. Long term effects on right ventricular performance merit further investigation.

CLINICAL IMPLICATIONS: Patients with isolated TV endocarditis that demonstrate bacteremia and/or systemic seeding may benefit from early surgical therapy.

DISCLOSURE: The following authors have nothing to disclose: Sharven Taghavi, Rachael Clark, Senthil Jayarajan, John Gaughan, Stacey Brann, Abeel Mangi

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Temple University Hospital, Philadelphia, PA

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