SURGICAL-TREATMENT OF TRICUSPID-VALVE END OCARDITIS - INDICATIONS, TECHNIQUE AND RESULTS

Tricuspid valve endocarditis is treated by antibiotics alone in the ma jority of the cases. However, intractable infection or hemodynamic com promise may warrant surgery. In those cases total valve-excision or va lve-replacement had been the most common surgical procedures. Both are controversial in regards to the hemodynamic consequences and to the l ong-term prognosis. In the following, results of tricuspid valve repai r in acute infective endocarditis are reported and discussed as an add itional 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). I n the cases with isolated tricuspid valve endocarditis, the indication for surgery was intractable infection in 6 and hemodynamically releva nt tricuspid-insufficiency in 1 out of 7 patients, respectively. In al l patients with associated left-sided endocarditis, the indication was hemodynamic deterioration. In 8 patients the tricuspid valve endocard itis was treated as follows: Debridement, vegectomy, patch-reconstruct ion 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 patient s, primary valve-replacement (n = 1) or valve-excision with secondary replacement (n = 2) was performed. In 4 patients tricuspid-reconstruct ion was combined with mitral(n = 1), aortic- (n = 1) or double-valve r eplacement (n = 2). 1 patient died early postoperatively in septic sho ck and multi-organ failure after valve-excision. In the other patients (n = 10) signs of infection vanished after surgery and tricuspid valv e endocarditis healed without recurrences. In 7 patients late echocard iographic follow-up showed tricuspid-regurgitation grade 0 in 3 patien ts, I in 2, II in 1 and III in 1, respectively. If surgery is indicate d, primary valve reconstruction is the treatment of choice for tricusp id valve endocarditis. Only if extensive valve destruction excludes va lve repair, would we now favor primary valve replacement over simple v alvulectomy.