Surgery for tricuspid valve endocarditis: a selective approach

The authors report their 18-year experience in the surgical treatment of in fective tricuspid endocarditis. Between January 1981 and January 1999, 238 cases of infective endocarditis were seen, with a tricuspid involvement in 21 cases (8.8%). Tricuspid valve repair was performed in 9 patients with in fective lesions involving one single leaflet. The surgical principle of the repair was to avoid any prosthetic material implantation. Posterior leafle t vegetectomy was performed in another 2 patients with infected intracavita ry leads. Tricuspid valve replacement was performed in 10 patients with inv olvement of the whole valvular apparatus. One patient died of septic shock 3 days postoperatively. All the other patients had a good postoperative rec overy. Follow-up ranged between 12 and 155 months (mean 68.9 +/- 55 months) . Five cases of late mortality were observed: 3 for cardiac reasons and 2 o f cancer. All the other patients are alive. Late postoperative echocardiogr aphy in the patients with tricuspid repair showed tricuspid regurgitation t o be absent in 6 patients, mild in 2, moderate in 1, and severe in 1. No re current infections were observed either in patients with valve repair or in those with valve replacement. Good early and long-term results can be achi eved in the surgical treatment of tricuspid endocarditis as long as complet e excision of the infected tissue is performed and risk factors are control led.