Comparison of Valveplasty and Replacement for Surgical Treatment of Infective Tricuspid Valve Endocarditis

Abstract Background In recent years, due to the increase in intravenous drug injection and intracardiac and vascular interventional treatments among drug users, infective endocarditis involving the right heart of the tricuspid valve has gradually increased.At present, there is no systematic report on surgical treatment of tricuspid infective endocarditis. This paper summarizes the experience of surgical treatment of 56 patients with tricuspid infective endocarditis in our hospital and analyzes its clinical effect. Methods From January 2006 to August 2019, 56 cases of tricuspid infective endocarditis treated by tricuspid valve surgery in our hospital were analyzed retrospectively.including 23 cases of tricuspid valvuloplasty (TVP) and 33 cases of tricuspid valve replacement (TVR). All patients were complicated with tricuspid valve vegetations or moderate and severe tricuspid regurgitation and had surgical indications.The perioperative data were collected and followed up for 6 months to 14 years to summarize and analyze the clinical effect of surgical treatment of tricuspid infective endocarditis. Results Compared with TVR group, the CPB time (79.68 ± 19.02min VS 107.39 ± 25.64min, P < 0.01), ACC time (50.29 ± 16.14min VS 65.52 ± 20.62min, P < 0.01), postoperative mechanical ventilation time (18.65 ± 8.18h VS 44.85 ± 57.68h, P < 0.01) and ICU stay time (38.13 ± 21.80h VS 102.64 ± 142.11h, P = 0.015) in TVP group were shorter. The perioperative red blood cell transfusion (4.87 ± 3.81U VS 7.55 ± 5.42U, P < 0.01) and the incidence of postoperative complications (8.7% VS 33.3%, P < 0.01) were lower.Perioperative death occurred in 1 case in the TVR group, and there was no perioperative death in the TVP group, There was no significant difference between the two groups(3.03% VS 0, P = 0.855). A total of 52 cases were followed up for an average of (5.50 ± 3.79) years.The postoperative 3-year, 5-year and 7-year survival rate were 100%,100%,91.7% in TVP group and 95.2%, 93.8% and 87.5%.The 5-year and 10-year reoperation rate were 0%, 0% in TVP group and 6.7%, 20% in TVR group. Conclusion Surgical treatment of severe tricuspid valve endocarditis has achieved good mid-term clinical results, and the rate of avoiding reoperation is better in TVP group than in TVR group.