Tricuspid Valve Repair for Infective Endocarditis with Periannular Involvement: Complete Valve Reconstruction

Background and aim of the study: Tricuspid valve (TV) infective endocarditis (TVIE) is uncommon and is mainly cured with medical treatment. When surgery is indicated, the appropriate surgical option remains to be determined. The study aim was to determine whether valve reconstruction using autologous pericardium is a safe and efficacious procedure to treat TVIE.

Methods: A retrospective review was conducted of patients who underwent surgery for acute isolated TVIE with periannular involvement. Radical debridement was performed to provide a safe ground for pericardium implantation. Untreated pericardial patches were prepared and sutured to the remaining part of the debrided annulus. Neochordae were fashioned with polytetrafluoroethylene sutures attached to the free edge of the pericardial neoleaflet.

Results: A total of 448 patients underwent TV surgery between September 2007 and May 2013 at the authors’

center. Nine patients (six males, three females; mean age 28 ± 4.9 years) underwent TV repair with pericardium for isolated TVIE. All male patients were intravenous drug users, and the three female patients had infected central venous catheters. Microbiology confirmed growth of Staphylococcus aureus alone in three cases, S. aureus and Candida sp. in two cases, methicillin-resistant S. aureus in one case, and Pseudomonas aeruginosa in one case. The culture was negative in two cases. There was no inhospital mortality, and the mean follow up was 16.4 ± 14.1 months. The latest follow up echocardiography revealed moderate tricuspid regurgitation in nine patients. Two non-cardiac-related deaths occurred, but there were no cases of recurrent endocarditis or reoperation.

Conclusion: Valve reconstruction utilizing autologous pericardium and neochordae could be used with acceptable results in isolated TVIE cases with periannular involvement.