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CC BY 4.0 · Avicenna J Med 2025; 15(02): 074-079
DOI: 10.1055/s-0045-1808059
Original Article

Surgical Intervention for Isolated Tricuspid Valve Endocarditis—Refining Patients' Selection

Ali Hage
1   Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
,
Rami Abazid 
2   Department of Medicine, Northern Ontario Medical School University, Sault Ste Marie, Ontario, Canada
,
Fadi Hage
1   Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
,
Shevan Bladia
3   College of Health Sciences, Western University, London, Ontario, Canada
,
Linrui Guo
1   Division of Cardiac Surgery, Department of Surgery, London Health Sciences Centre, Western University, London, Ontario, Canada
,
Nikolaos Tzemos
4   Division of Cardiology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
› Author Affiliations
Funding Sources None.
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Abstract

Background

In this study, we analyzed various clinical and imaging factors of patients with isolated tricuspid valve infective endocarditis (TVIE) who have undergone surgical intervention, and assessed short- and long-term outcomes after surgery.

Methods

We retrospectively enrolled 26 patients diagnosed with definite isolated TVIE and underwent surgical intervention between February 2004 and August 2019. We collected patients' demographics, preoperative and postoperative data. The primary outcomes were death and a composite of the following: death, readmission with right-sided heart failure, or recurrent endocarditis.

Results

A total of 29 isolated tricuspid valve surgical interventions were performed on 26 patients. The mean age was 38.6 ± 12.3 years. In total, 22/29 (75.8%) of TVIE were related to Staphylococcus aureus and 4/29 (13.8%) were secondary to fungal infection. During a follow-up of 5.4 ± 3.7 years, there were 9 (34.6%) deaths and 15 (57.7%) composite outcomes. Multivariable Cox regression analysis showed that male sex (hazard ratio [HR]: 16.68, 95% confidence interval [CI]: 1.63–170.34, p = 0.018) and intravenous drug users (IVDU) (HR: 25.66, 95% CI: 1.87–352.79, p = 0.015) are significantly associated with increase death; on the other hand, higher level of preoperative hemoglobin and preoperative left ventricular ejection fraction (LVEF) was found to have decreased hazard of death: HR: 0.90, 95% CI: 0.82–0.99, p = 0.033 and HR: 0.92, 95% CI: 0.86–0.98, p = 0.013, respectively.

Conclusion

In our institution, surgical intervention for isolated TVIE has a mortality rate of 34.6%. Men, a history of IVDU, lower preoperative hemoglobin levels, and reduced LVEF were significant predictors of postsurgical mortality. Earlier surgical intervention for TVIE before the development of anemia or impaired LV systolic function may have a potential survival benefit.

Keywords

tricuspid valve - infective endocarditis - tricuspid regurgitation

Ethics Approval and Consent to Participate

Informed consent was waived by the ethics committee of the Lawson Health Research Institute (approval number: R-18-457) due to the retrospective nature of the study.


Consent for Publication

Not applicable.


Availability of Data and Materials

Data will be available upon proper request to the corresponding author.


Authors' Contribution

N.T. and A. H conceptualized and designed the study. A.H., F.H., R.A., and S.B. did the literature review. F.H., A.H., and L.G. did the acquisition of data and data collection. A.H. and R.A. analyzed and interpreted the data. A.H., F.H., R.A., and S.B. drafted the manuscript. A.H. and F.H. worked on generating the figures. N.T. supervised the research. All authors critically revised and edited the manuscript for important intellectual content. All authors reviewed and agreed on the content of the manuscript and the revised manuscript.




Publication History

Article published online:
02 June 2025

© 2025. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution License, permitting unrestricted use, distribution, and reproduction so long as the original work is properly cited. (https://creativecommons.org/licenses/by/4.0/)

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