Surgical strategy in tricuspid valve endocarditis

Abstract

Until recent years, the infective endocarditis of the right heart was considered extremely rare. In the last 20 years the incidence of this disease is increasing, especially for the isolated tricuspid valve infective endocarditis. Most frequent causes are: drug abuse, uterine infections, cardiac implantable electronic devices like pacemakers/defibrillators leads, other intracardiac devices or cardiac malformations. Medical treatment with antibiotics is the mainstay option but surgery is often required for a group of patients. Surgical interventions include valvectomy (total excision of the tricuspid valve without substitution), reconstruction or valve replacement. Surgical strategy in tricuspid valve endocarditis can produce satisfactory results. The clear indication and timing of surgery remain debatable. Association with intravenous antibiotics is of paramount importance. Conservative techniques are the first choice but replacement remains an option when repair is not feasible. However, there is no clear evidence supporting one technique over another.