Surgery, mechanical aspiration do not prevent death in tricuspid valve infective endocarditis

Valve surgery or percutaneous mechanical aspiration, in combination with medical therapy, fall short of providing survival benefits to patients with isolated tricuspid valve infective endocarditis, results of a study have shown. However, addiction medicine consultation appears to be protective against the risk of death at 1 year in this population.

This retrospective cohort study was conducted in 215 patients with isolated tricuspid valve infective endocarditis over a 10-year period, between 1 January 2009 and 31 December 2018.

The authors obtained demographic- and outcomes-related data by reviewing the medical records of the participants. They also examined the association between treatment group and outcomes using Cox proportional hazard regression with inverse probability of treatment weighting.

Of the patients, 100 (46.5 percent) were managed medically, 49 (22.8 percent) were treated through surgery, and 66 (30.7 percent) received percutaneous mechanical aspiration.

Mortality at 1 year did not differ significantly among the three treatment groups (p=0.15). Notably, vegetation size >2.0 cm significantly correlated with increased 1-year mortality (hazard ratio, 3.01; p=0.03), while addiction medicine consultation significantly correlated with decreased 1-year mortality (hazard ratio, 0.117; p=0.0008).

“The opioid pandemic, and particularly injection drug use, has led to an increase in cases of tricuspid valve infective endocarditis,” the authors said.

“Indications for valve surgery in right-sided infective endocarditis are not well-defined. Percutaneous mechanical aspiration is considered an alternative in patients at high risk for reinfection of a prosthetic valve but lacks robust outcomes data,” they added.