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Tricuspid Valve Surgery in Patients with Isolated Tricuspid Valve Endocarditis - Analyzation of Perioperative Parameters and Long-Term Outcomes
Bettina Pfannmueller, Mareike Kahmann, Christian Binner, Piroze Davierwala, Martin Misfeld, Jens Garbade, Pascal Dohmen, Christian Etz, Michael A. Borger, Friedrich W. Mohr.
Heart Center Leipzig, Leipzig, Germany.

Objective: Aim of this study was to investigate the perioperative conditions as well as short- and mid-term outcome of patients with isolated TV endocarditis undergoing TV surgery.
Methods: Between June 1995 and February 2012, a total of 56 patients with isolated TV endocarditis underwent TV surgery at the Leipzig Heart Center. Mean age was 53.8±17.1 years, mean LVEF 60.4±9.9%, 39 patients (69.6%) were male, 21 patients (37.5%) suffered from renal failure, 13 patients (23.2%) from diabetes mellitus. Average logEuroSCORE was 19,4 ± 17.00%. Follow-up was in average 5,4 ± 3,9 years.
Results: Microbiological investigations of blood cultures and intraoperative material of the TV tissue/ vegetations were in 52 patients (92.9%) positive and showed as the reason for TV endocarditis staphylococcus aureus in 24 patients (42.9%) and coagulase negative staphylococcus in another 10 patients (17.9%). The focus for developing TV endocarditis was in 19 patients (33.9%) due to foreign material - especially pacemaker wires in 15 patients (26.8%) - intravenous drug abusus was seen additionally in 11 patients (19.6%). A TV-replacement was performed in 23 patients (39.3%), TV repair with annuloplasty in 13 patients (23.2%), in 21 patients (37.5%) TV surgery was performed on the leaflet level (e.g. patchplastik, vegetatectomy). Overall 30-day mortality was 12.7%. Five year survival was 62.8% (95% CI 5.3-11.5 years). The incidence for TV-related reoperation after 5 years was 7.5% (95% CI 6.4-8.7%) and was in 4 of 5 patients due to TV-reendocarditis - two of these with recurrent intravenous drug-abusus, one patient with a pacemaker-wire and one patient with Re-Re TV endocarditis due to immunosuppression (acute leukaemia).
Conclusions: TV surgery due to TV endocarditis often concerns patients with intravenous drug abusus, intravenous foreign material and/or patients with immunosuppression. Foreign material should be avoided in the case of TV-surgery so far as possible to diminish the risk of reendocarditis, especially in patients with intravenous drug-abusus.

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