Cardiol Res

Cardiology Research, ISSN 1923-2829 print, 1923-2837 online, Open Access

Article copyright, the authors; Journal compilation copyright, Cardiol Res and Elmer Press Inc

Journal website https://www.cardiologyres.org

Short Communication

Volume 13, Number 2, April 2022, pages 110-117

Isolated Tricuspid Valve Replacement for Infective Endocarditis

Figure 1. Preoperative echocardiography. (a, b) Treated endocarditis: (a) Severely dilated tricuspid valve annulus measuring 59 mm (arrows), with non-coapting tricuspid valve leaflets. (b) Dilated tricuspid valve annulus (arrows) measuring 39 mm, with central malcoaptation and severe tricuspid regurgitation. (c, d) Active endocarditis: large, mobile vegetations (arrows) on damaged tricuspid valve leaflets.

**Table 1.** Preoperative Data
	All, n = 7 (%)
Values for continuous variables are expressed as mean ± standard deviation. Values for categorical variables are expressed as numbers (%).
Demographics
Age (years)	41.0 ± 14.1
Male	6 (86)
Body surface area (m²)	1.7 ± 0.1
Body mass index (kg/m²)	23.3 ± 8.2
Preoperative New York Heart Association class
II	2 (29%)
III	1 (14%)
IV	4 (57%)
Causative organism
Methicillin-sensitive Staphylococcus aureus	5 (71%)
Methicillin-resistant Staphylococcus aureus	1 (14%)
Streptococcus and Neisseria	1 (14%)
Nature of infective endocarditis
Active	5 (71%)
Treated	2 (29%)
Comorbidities
Atrial fibrillation	1 (14%)
Hypertension	1 (14%)
Hyperlipidemia	0
Diabetes mellitus	0
Ischemic heart disease	0
Chronic kidney disease	1 (14%)
Cerebrovascular accident	1 (14%)
Chronic hepatitis C infection	5 (71%)
Liver cirrhosis	0
Human immunodeficiency virus	0
Preoperative laboratory investigations
Hemoglobin (g/L)	9.9 ± 2.8
Platelet (× 10⁹/L)	112.0 ± 73.3
Creatinine (µmol/L)	138.0 ± 170.0
Bilirubin (µmol/L)	23.0 ± 17.0
Albumin (g/L)	24.0 ± 8.7
Aspartate transaminase (IU/L)	38.0 ± 13.8
Alanine transaminase (IU/L)	40.0 ± 14.1
Echocardiography
Preoperative left ventricular ejection fraction (%)	54.0 ± 10.1
Severe tricuspid regurgitation	7 (100%)
Tricuspid valve vegetation size (mm) (n = 5)	24.6 ± 16.1
Pulmonary artery systolic pressure (mm Hg)	60.9 ± 16.2

Table 1. Preoperative Data

All, n = 7 (%)

Values for continuous variables are expressed as mean ± standard deviation. Values for categorical variables are expressed as numbers (%).

Demographics

Age (years)

41.0 ± 14.1

Male

6 (86)

Body surface area (m²)

1.7 ± 0.1

Body mass index (kg/m²)

23.3 ± 8.2

Preoperative New York Heart Association class

2 (29%)

III

1 (14%)

4 (57%)

Causative organism

Methicillin-sensitive Staphylococcus aureus

5 (71%)

Methicillin-resistant Staphylococcus aureus

1 (14%)

Streptococcus and Neisseria

1 (14%)

Nature of infective endocarditis

Active

5 (71%)

Treated

2 (29%)

Comorbidities

Atrial fibrillation

1 (14%)

Hypertension

1 (14%)

Hyperlipidemia

Diabetes mellitus

Ischemic heart disease

Chronic kidney disease

1 (14%)

Cerebrovascular accident

1 (14%)

Chronic hepatitis C infection

5 (71%)

Liver cirrhosis

Human immunodeficiency virus

Preoperative laboratory investigations

Hemoglobin (g/L)

9.9 ± 2.8

Platelet (× 10⁹/L)

112.0 ± 73.3

Creatinine (µmol/L)

138.0 ± 170.0

Bilirubin (µmol/L)

23.0 ± 17.0

Albumin (g/L)

24.0 ± 8.7

Aspartate transaminase (IU/L)

38.0 ± 13.8

Alanine transaminase (IU/L)

40.0 ± 14.1

Echocardiography

Preoperative left ventricular ejection fraction (%)

54.0 ± 10.1

Severe tricuspid regurgitation

7 (100%)

Tricuspid valve vegetation size (mm) (n = 5)

24.6 ± 16.1

Pulmonary artery systolic pressure (mm Hg)

60.9 ± 16.2

**Table 2.** Operative and Postoperative Data
	All, n = 7 (%)
Values for continuous variables are expressed as mean ± standard deviation. Values for categorical variables are expressed as numbers (%).
Operative parameters
Aortic cross clamp time (min)	49 ± 13
Cardiopulmonary bypass time (min)	90 ± 31
Valve replacement
Mechanical	2 (29)
Bioprosthetic	5 (71)
Postoperative complications
Re-exploration for mediastinal bleeding	1 (14)
Infection
Wound	1 (14)
Pneumonia	2 (29)
Low cardiac output syndrome	0
Acute kidney injury	0
Permanent pacemaker	0
Length of stay (days)	34 ± 21
Postoperative New York Heart Association class
I	2 (29)
II	2 (29)
III	3 (43)
Echocardiography
Postoperative left ventricular ejection fraction (%)	57.2 ± 9.6

Table 2. Operative and Postoperative Data

All, n = 7 (%)

Values for continuous variables are expressed as mean ± standard deviation. Values for categorical variables are expressed as numbers (%).

Operative parameters

Aortic cross clamp time (min)

49 ± 13

Cardiopulmonary bypass time (min)

90 ± 31

Valve replacement

Mechanical

2 (29)

Bioprosthetic

5 (71)

Postoperative complications

Re-exploration for mediastinal bleeding

1 (14)

Infection

Wound

1 (14)

Pneumonia

2 (29)

Low cardiac output syndrome

Acute kidney injury

Permanent pacemaker

Length of stay (days)

34 ± 21

Postoperative New York Heart Association class

2 (29)

III

3 (43)

Echocardiography

Postoperative left ventricular ejection fraction (%)

57.2 ± 9.6

Table 3. Summary Table of Seven Patients Undergoing Isolated Tricuspid Valve Replacement for Infective Endocarditis

Patient

Gender

Age

Preoperative NYHA class

Comorbidities/PASP

Vegetation size/septic emboli

Indication(s) for surgery

Procedure

Follow-up (months)

Complications

Latest NYHA class

M: male; F: female; AF: atrial fibrillation; BMI: body mass index; IE: infective endocarditis; IVDU: intravenous drug use; NYHA: New York Heart Association; PASP: pulmonary artery systolic pressure; TR: tricuspid regurgitation; TV: tricuspid valve; TVR: tricuspid valve replacement.

IVDU/chronic hepatitis C/AF

No vegetation/no emboli

Heart failure

Mechanical TVR

Nil

PASP 70 mm Hg

IVDU/hypertension

32 mm/lung

Heart failure

Bioprosthetic TVR

Prosthetic valve IE

III

Recurrent IVDU

PASP 52 mmHg

Death from prosthetic valve IE 13 months after initial TVR

Chronic kidney disease

40 mm/lung

Persistent sepsis

Bioprosthetic TVR

Re-exploration for postoperative mediastinal bleeding

PASP 72 mm Hg

Wound infection

III

IVDU/chronic hepatitis C

17 mm/lung

Persistent sepsis

Mechanical TVR

Postoperative pneumonia

III

Prosthetic valve IE

PASP 55 mm Hg

Recurrent IVDU

Death from prosthetic valve IE 8 months after initial TVR

IVDU

34 mm/lung

Persistent sepsis

Bioprosthetic TVR

129

Nil

PASP 39 mm Hg

IVDU/chronic hepatitis C/previous stroke

27 mm/lung

Heart failure Persistent sepsis

Bioprosthetic TVR

Postoperative pneumonia

III

Recurrent prosthetic valve IE

Reoperative TVR 3 months after initial TVR

Death from prosthetic valve IE 7 months after initial TVR

PASP 87 mm Hg

IVDU/chronic Hepatitis C/smoker/obesity (BMI 41.5 kg/m²)

No vegetation/nil

Heart failure

Unsuccessful TV repair/bioprosthetic TVR

127

Severe stenosis of bioprosthetic TV and moderate TR

PASP 51 mm Hg