Abstract
Tricuspid valve endocarditis is treated by antibiotics alone in the majority of the cases. However, intractable infection or hemodynamic compromise may warrant surgery. In those cases total valve-excision or valve-replacement had been the most common surgical procedures. Both are controversial in regards to the hemodynamic consequences and to the long-term prognosis. In the following, results of tricuspid valve repair in acute infective endocarditis are reported and discussed as an additional treatment option. Between January 1988 and December 1993, 118 patients were operated for acute valve endocarditis at our institution. Eleven of these patients had tricuspid valve endocarditis, isolated (n = 7) or combined with endocarditis of a left-sided valve (n = 4). In the cases with isolated tricuspid valve endocarditis, the indication for surgery was intractable infection in 6 and hemodynamically relevant tricuspid-insufficiency in 1 out of 7 patients, respectively. In all patients with associated left-sided endocarditis, the indication was hemodynamic deterioration. In 8 patients the tricuspid valve endocarditis was treated as follows: Debridement, vegectomy, patch-reconstruction of the cusps, bicuspidalization. In 3 patients reconstruction was not possible because of extended involvement of all parts of the valve, including the valve ring and the papillary muscles. In these patients, primary valve-replacement (n = 1) or valve-excision with secondary replacement (n = 2) was performed. In 4 patients tricuspid-reconstruction was combined with mitral (n = 1), aortic- (n = 1) or double-valve replacement (n = 2). 1 patient died early postoperatively in septic shock and multi-organ failure after valve-excision. In the other patients (n = 10) signs of infection vanished after surgery and tricuspid valve endocarditis healed without recurrences. In 7 patients late echocardiographic follow-up showed tricuspid-regurgitation grade 0 in 3 patients, I in 2, II in 1 and III in 1, respectively. If surgery is indicated, primary valve reconstruction is the treatment of choice for tricuspid valve endocarditis. Only if extensive valve destruction excludes valve repair, would we now favor primary valve replacement over simple valvulectomy.
Translated title of the contribution | Surgical treatment of tricuspid valve endocarditis: Indications, technique and results |
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Original language | German |
Pages (from-to) | 921-929 |
Number of pages | 9 |
Journal | Zeitschrift fur Kardiologie |
Volume | 84 |
Issue number | 11 |
State | Published - 1995 |
Externally published | Yes |