TRICUSPID-VALVE RECONSTRUCTION, A TREATMENT OPTION IN ACUTE ENDOCARDITIS

Tricuspid valve endocardititis is treated surgically by total valve ex cision or valve replacement. Both procedures are controversial with re gard to the hemodynamic consequences and to the long-term prognosis. I n the following, results of tricuspid valve repair in acute infective endocarditis are reported and discussed as an additional treatment opt ion. Between January 1988 and December 1993, 118 patients were operate d on 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 is olated tricuspid valve endocarditis. the indication for surgery was in tractable infection in six and hemodynamically relevant tricuspid insu fficiency in one out of seven patients. In all patients with associate d left-sided endocarditis, the indication was hemodynamic deterioratio n. In eight patients the tricuspid valve endocarditis was treated as f ollows: debridement, vegectomy, patch reconstruction of the cusps, red ucing the cusps to two. In three patients reconstruction was not possi ble because of extensive involvement of all parts of the valve, includ ing the valve ring and the papillary muscles. In these patients primar y valve replacement (n = 1) or valve excision with secondary replaceme nt (n = 2) was performed. In four patients tricuspid reconstruction wa s combined with mitral (n = 1), aortic (n = 1) or double valve replace ment (n = 2). Postoperatively, signs of infection vanished in all surv iving patients (n = 10) and tricuspid valve endocarditis healed withou t recurrences. Implanted prosthetic material did not lead to recurrent infection. One patient died early postoperatively after valve excisio n, in septic shock and multi-organ failure. In seven patients late ech ocardiographic follow-up showed tricuspid regurgitation grade 0 in thr ee patients, I in two, II in one and III in one. Our results suggest t hat valve repair is a reasonable treatment option for tricuspid valve endocarditis in all cases with localized infection of the valve. Only if extensive valve destruction excludes valve repair, would we now fav or primary valve replacement over simple valvulectomy. In all other ca ses primary valve reconstruction is the treatment of choice for tricus pid valve endocarditis, if surgery is indicated.