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Isolated tricuspid valve surgery: The devil is infective endocarditis?

  • Bo Xu
    Correspondence
    Corresponding author at: Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart and Vascular Institute, Cleveland Clinic, Cleveland, OH 44195, USA.
    Affiliations
    Section of Cardiovascular Imaging, Robert and Suzanne Tomsich Department of Cardiovascular Medicine, Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute, Cleveland Clinic, Cleveland, OH 44195, USA
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  • Mohamed Khayata
    Affiliations
    Department of Cardiovascular Sciences, University of South Florida Morsani College of Medicine, Tampa, FL 33606, USA
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Published:November 02, 2022DOI:https://doi.org/10.1016/j.ijcard.2022.10.164
      Tricuspid valve regurgitation (TVR) is an important valve disease with limited outcomes data on its management [
      • Otto C.M.
      • Nishimura R.A.
      • Bonow R.O.
      • et al.
      ACC/AHA guideline for the Management of Patients with Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines.
      ]. Isolated tricuspid valve (ITV) disease occurs in approximately 90% of right-sided valvular infections [
      • Witten J.C.
      • Hussain S.T.
      • Shrestha N.K.
      • et al.
      Surgical treatment of right-sided infective endocarditis.
      ]. Out of all patients with TVR, only 5% have primary TVR [
      • Wang T.K.M.
      • Akyuz K.
      • Mentias A.
      • et al.
      Contemporary etiologies, outcomes, and novel risk score for isolated tricuspid regurgitation.
      ]. The most common causes for primary TVR include endocarditis (approximately 50%) followed by degenerative changes or prolapse and prosthetic valve failure [
      • Wang T.K.M.
      • Akyuz K.
      • Mentias A.
      • et al.
      Contemporary etiologies, outcomes, and novel risk score for isolated tricuspid regurgitation.
      ]. The most common causes of secondary TVR, on the other hand, are left heart disease, followed by pulmonary disease and atrial functional TVR [
      • Wang T.K.M.
      • Unai S.
      • Xu B.
      Contemporary review in the multi-modality imaging evaluation and management of tricuspid regurgitation.
      ]. Current guidelines recommend consideration of tricuspid valve surgery in patients with severe TVR with symptoms or reduced right ventricular function [
      • Otto C.M.
      • Nishimura R.A.
      • Bonow R.O.
      • et al.
      ACC/AHA guideline for the Management of Patients with Valvular Heart Disease: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines.
      ]. However, the data for ITV surgery are limited. Isolated tricuspid valve surgery has higher reported risk for perioperative adverse events and worse long-term survival compared to other valvular procedures, [
      • Hamandi M.
      • Smith R.L.
      • Ryan W.H.
      • et al.
      Outcomes of isolated tricuspid valve surgery have improved in the modern era.
      ] with an estimated in hospital mortality up to 16% [
      • Di Mauro M.
      • Russo M.
      • Saitto G.
      • et al.
      Prognostic role of endocarditis in isolated tricuspid valve surgery. A propensity-weighted study.
      ]. Out of all ITV replacements, infective endocarditis (IE) represents the main surgical indication in approximately one third of cases [
      • Dreyfus J.
      • Flagiello M.
      • Bazire B.
      • et al.
      Isolated tricuspid valve surgery: impact of aetiology and clinical presentation on outcomes.
      ].
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