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Outcomes After Tricuspid Valve Operations in Patients With Drug-Use Infective Endocarditis

Published:October 22, 2022DOI:https://doi.org/10.1016/j.amjcard.2022.08.033
      The increase of intravenous drug use has led to an increase in right-sided infective endocarditis and its complications including septic pulmonary embolism. The objective of this study was to compare the outcomes of tricuspid valve (TV) operations in patients with drug-use infective endocarditis (DU-IE) complicated by septic pulmonary emboli (PE). Hospitalizations for DU-IE complicated by septic PE were identified from the National Inpatient Sample from 2002 to 2019. Outcomes of patients who underwent TV operations were compared with medical management. The primary outcome was the incidence of major adverse cardiovascular events (MACEs), defined as in-hospital mortality, myocardial infarction, stroke, cardiogenic shock, or cardiac arrest. An inverse probability of treatment weighted analysis was utilized to adjust for the differences between the cohorts. A total of 9,029 cases of DU-IE with septic PE were identified (mean age 33.6 years), of which 818 patients (9.1%) underwent TV operation. Surgery was associated with a higher rate of MACE (14.5% vs 10.8%, p <0.01), driven by a higher rate of cardiogenic shock (6.1% vs 1.2%, p <0.01) but a lower rate of mortality (2.7% vs 5.7%, p <0.01). Moreover, TV operation was associated with an increased need for permanent pacemakers, blood transfusions, and a higher risk of acute kidney injury. In the inverse probability treatment weighting analysis, TV operation was associated with an increased risk for MACE driven by a higher rate of cardiogenic shock and cardiac arrest, but a lower rate of mortality when compared with medical therapy alone. In conclusion, TV operations in patients with DU-IE complicated by septic PE are associated with an increased risk for MACE but a decreased risk of mortality. Although surgical management may be beneficial in some patients, alternative options such as percutaneous debulking should be considered given the higher risk.
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      References

        • Pant S
        • Patel NJ
        • Deshmukh A
        • Golwala H
        • Patel N
        • Badheka A
        • Hirsch GA
        • Mehta JL.
        Trends in infective endocarditis incidence, microbiology, and valve replacement in the United States from 2000 to 2011.
        J Am Coll Cardiol. 2015; 65: 2070-2076
        • Mori M
        • Brown KJ
        • Bin Mahmood SU
        • Geirsson A
        • Mangi AA.
        Trends in infective endocarditis hospitalizations, characteristics, and valve operations in patients with opioid use disorders in the United States: 2005–2014.
        J Am Heart Assoc. 2020; 9e012465
        • Rudasill SE
        • Sanaiha Y
        • Mardock AL
        • Khoury H
        • Xing H
        • Antonios JW
        • McKinnell JA
        • Benharash P.
        Clinical outcomes of infective endocarditis in injection drug users.
        J Am Coll Cardiol. 2019; 73: 559-570
        • Baddour LM
        • Wilson WR
        • Bayer AS
        • Fowler VG
        • Jr Tleyjeh IM
        • Rybak MJ
        • Barsic B
        • Lockhart PB
        • Gewitz MH
        • Levison ME
        • Bolger AF
        • Steckelberg JM
        • Baltimore RS
        • Fink AM
        • O'Gara P
        • Taubert KA
        • American Heart Association Committee on Rheumatic Fever, Endocarditis, and Kawasaki Disease of the Council on Cardiovascular Disease in the Young, Council on Clinical Cardiology, Council on Cardiovascular Surgery and Anesthesia, and Stroke Council
        Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association.
        Circulation, Antimicrobial Therapy. 2015; 132: 1435-1486
        • Dawood MY
        • Cheema FH
        • Ghoreishi M
        • Foster NW
        • Villanueva RM
        • Salenger R
        • Griffith BP
        • Gammie JS.
        Contemporary outcomes of operations for tricuspid valve infective endocarditis.
        Ann Thorac Surg. 2015; 99: 539-546
        • Schranz AJ
        • Fleischauer A
        • Chu VH
        • Wu LT
        • Rosen DL.
        Trends in drug use-associated infective endocarditis and heart valve surgery, 2007 to 2017: a study of statewide discharge data.
        Ann Intern Med. 2019; 170: 31-40
        • Musci M
        • Siniawski H
        • Pasic M
        • Grauhan O
        • Weng Y
        • Meyer R
        • Yankah CA
        • Hetzer R.
        Surgical treatment of right-sided active infective endocarditis with or without involvement of the left heart: 20-year single center experience.
        Eur J Cardiothorac Surg. 2007; 32: 118-125
        • Akinosoglou K
        • Apostolakis E
        • Koutsogiannis N
        • Leivaditis V
        • Gogos CA.
        Right-sided infective endocarditis: surgical management.
        Eur J Cardiothorac Surg. 2012; 42: 470-479
        • Martín-Dávila P
        • Navas E
        • Fortún J
        • Moya JL
        • Cobo J
        • Pintado V
        • Quereda C
        • Jiménez-Mena M
        • Moreno S.
        Analysis of mortality and risk factors associated with native valve endocarditis in drug users: the importance of vegetation size.
        Am Heart J. 2005; 150: 1099-1106
        • Carozza A
        • De Santo LS
        • Romano G
        • Della Corte A
        • Ursomando F
        • Scardone M
        • Caianiello G
        • Cotrufo M
        Infective endocarditis in intravenous drug abusers: patterns of presentation and long-term outcomes of surgical treatment.
        J Heart Valve Dis. 2006; 15: 125-131
        • Gaca JG
        • Sheng S
        • Daneshmand M
        • Rankin JS
        • Williams ML
        • O'Brien SM
        • Gammie JS.
        Current outcomes for tricuspid valve infective endocarditis surgery in North America.
        Ann Thorac Surg. 2013; 96: 1374-1381
        • Baraki H
        • Saito S
        • Al Ahmad A
        • Fleischer B
        • Schmitto J
        • Haverich A
        • Kutschka I
        Surgical treatment for isolated tricuspid valve endocarditis- long-term follow-up at a single institution.
        Circ J. 2013; 77: 2032-2037
        • Habib G
        • Lancellotti P
        • Antunes MJ
        • Bongiorni MG
        • Casalta JP
        • Del Zotti F
        • Dulgheru R
        • El Khoury G
        • Erba PA
        • Iung B
        • Miro JM
        • Mulder BJ
        • Plonska-Gosciniak E
        • Price S
        • Roos-Hesselink J
        • Snygg-Martin U
        • Thuny F
        • Tornos Mas P
        • Vilacosta I
        • Zamorano JL
        • ESC Scientific Document Group
        2015 ESC Guidelines for the management of infective endocarditis: the Task Force for the Management of Infective Endocarditis of the European Society of Cardiology (ESC). Endorsed by: European Association for Cardio-Thoracic Surgery (EACTS), the European association of nuclear medicine (EANM).
        Eur Heart J. 2015; 36: 3075-3128
        • Rabkin DG
        • Mokadam NA
        • Miller DW
        • Goetz RR
        • Verrier ED
        • Aldea GS.
        Long-term outcome for the surgical treatment of infective endocarditis with a focus on intravenous drug users.
        Ann Thorac Surg. 2012; 93: 51-57
        • Pfannmueller B
        • Kahmann M
        • Davierwala P
        • Misfeld M
        • Bakhtiary F
        • Binner C
        • Etz C
        • Mohr FW.
        Tricuspid valve surgery in patients with isolated tricuspid valve endocarditis: analysis of perioperative parameters and long-term outcomes.
        Thorac Cardiovasc Surg. 2017; 65: 626-633
        • Hamandi M
        • Smith RL
        • Ryan WH
        • Grayburn PA
        • Vasudevan A
        • George TJ
        • DiMaio JM
        • Hutcheson KA
        • Brinkman W
        • Szerlip M
        • Moore DO
        • Mack MJ.
        Outcomes of isolated tricuspid valve surgery have improved in the modern era.
        Ann Thorac Surg. 2019; 108: 11-15
        • Topilsky Y
        • Khanna AD
        • Oh JK
        • Nishimura RA
        • Enriquez-Sarano M
        • Jeon YB
        • Sundt TM
        • Schaff HV
        • Park SJ.
        Preoperative factors associated with adverse outcome after tricuspid valve replacement.
        Circulation. 2011; 123: 1929-1939
        • Carrier M
        • Hébert Y
        • Pellerin M
        • Bouchard D
        • Perrault LP
        • Cartier R
        • Basmajian A
        • Pagé P
        • Poirier NC.
        Tricuspid valve replacement: an analysis of 25 years of experience at a single center.
        Ann Thorac Surg. 2003; 75: 47-50
        • Raikhelkar J
        • Lin HM
        • Neckman D
        • Afonso A
        • Scurlock C.
        Isolated tricuspid valve surgery: predictors of adverse outcome and survival.
        Heart Lung Circ. 2013; 22: 211-220
        • Ren WJ
        • Zhang BG
        • Liu JS
        • Qian YJ
        • Guo YQ.
        Outcomes of tricuspid annuloplasty with and without prosthetic rings: a retrospective follow-up study.
        J Cardiothorac Surg. 2015; 10: 81
        • Al-Bawardy R
        • Krishnaswamy A
        • Bhargava M
        • Dunn J
        • Wazni O
        • Tuzcu EM
        • Stewart W
        • Kapadia SR.
        Tricuspid regurgitation in patients with pacemakers and implantable cardiac defibrillators: a comprehensive review.
        Clin Cardiol. 2013; 36: 249-254
        • Sridhara S
        • Mayer PA.
        Medical and ethical concerns Regarding pacemaker implantation in a patient with substance use disorder.
        Cureus. 2018; 10: e3027
        • Mori M
        • Bin Mahmood SU
        • Schranz AJ
        • Sultan I
        • Axtell AL
        • Sarsour N
        • Hiesinger W
        • Boskovski MT
        • Hirji S
        • Kaneko T
        • Woo J
        • Tang P
        • Jassar AS
        • Atluri P
        • Whitson BA
        • Gleason T
        • Geirsson A.
        Risk of reoperative valve surgery for endocarditis associated with drug use.
        J Thorac Cardiovasc Surg. 2020; 159: 1262-1268.e2
        • Straw S
        • Baig MW
        • Gillott R
        • Wu J
        • Witte KK
        • O'Regan DJ
        • Sandoe JAT.
        Long-term outcomes are poor in intravenous drug users following infective endocarditis, even After surgery.
        Clin Infect Dis. 2020; 71: 564-571
        • Protos AN
        • Trivedi JR
        • Whited WM
        • Rogers MP
        • Owolabi U
        • Grubb KJ
        • Sell-Dottin K
        • Slaughter MS.
        Valvectomy versus replacement for the surgical treatment of tricuspid endocarditis.
        Ann Thorac Surg. 2018; 106: 664-669
        • Gottardi R
        • Bialy J
        • Devyatko E
        • Tschernich H
        • Czerny M
        • Wolner E
        • Seitelberger R.
        Midterm follow-up of tricuspid valve reconstruction due to active infective endocarditis.
        Ann Thorac Surg. 2007; 84: 1943-1948
        • Bangalore S
        • Alviar CL
        • Vlahakis S
        • Keller N.
        Tricuspid valve vegetation debulking using the AngioVac system.
        Catheter Cardiovasc Interv. 2021; 98: E475-E477
        • Starck CT
        • Dreizler T
        • Falk V.
        The AngioVac system as a bail-out option in infective valve endocarditis.
        Ann Cardiothorac Surg. 2019; 8: 675-677
        • Divekar AA
        • Scholz T
        • Fernandez JD.
        Novel percutaneous transcatheter intervention for refractory active endocarditis as a bridge to surgery-angiovac aspiration system.
        Catheter Cardiovasc Interv. 2013; 81: 1008-1012
        • Akhtar YN
        • Walker WA
        • Shakur U
        • Smith G
        • Husnain SS
        • Adigun SF.
        Clinical outcomes of percutaneous debulking of tricuspid valve endocarditis in intravenous drug users.
        Catheter Cardiovasc Interv. 2021; 97: 1290-1295
        • Veve MP
        • Akhtar Y
        • McKeown PP
        • Morelli MK
        • Shorman MA.
        Percutaneous mechanical aspiration vs valve surgery for tricuspid valve endocarditis in people who inject drugs.
        Ann Thorac Surg. 2021; 111: 1451-1457