1. Introduction

Infective endocarditis carries high mortality and mortality. Murdoch et al. studied 2781 adults with definite infective endocarditis admitted to 58 hospitals in 25 countries [1]. They reported that surgical treatment was performed in 48%, and in-hospital mortality was 18%. Nevertheless, surgery during the current endocarditis episode was associated with decreased risk of inhospital death (odds ratio, 0.56; 95% confidence interval, 0.44-0.69).

© 2016 The Author(s). Licensee InTech. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and eproduction in any medium, provided the original work is properly cited. © 2018 The Author(s). Licensee IntechOpen. This chapter is distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Tricuspid valve infective endocarditis was relatively rare and accounted for 5 to 10% of all infective endocarditis [2]. In the study of Murdoch et al. which was reported in 2009 [1], tricuspid valve infective endocarditis was found in 12% of the entire cohort. However, the frequency of tricuspid valve infective endocarditis is rapidly increasing along with the epidemic of intravenous drug use. Seratnahaei et al. reported that the incidence of tricuspid valve infective endocarditis was 6% between 1999 and 2000, and it markedly increased to 36% between 2009 and 2010 [3]. Also reported history of intravenous drug use increased from 15 to 40%.

Kiefer et al. performed a prospective, multicenter study enrolling over 4000 patients with infective endocarditis and known heart failure status [10]. In-hospital mortality was lower in the patients undergoing valvular surgery compared with medical therapy alone (20.6 vs. 44.8%, p < 0.001), and 1-year mortality was also lower in patients undergoing surgery com-

Surgical Treatment for Tricuspid Valve Infective Endocarditis

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The early surgical intervention for left-sided infective endocarditis has been well suggested [7, 11, 12]; however, the surgical indications for right-sided infective endocarditis are not

Akinosoglou et al. suggested that the timing of surgical management depends on the following factors: [1] cause of endocarditis (e.g. urgent in pacemaker and prosthetic infective endocarditis), [2] causative infective factors (e.g. fungal and Staphylococcus aureus), [3] coexistent left-sided infection, [4] response to antibiotic therapy, [5] toxicity of medical treatment, and [6]

Early surgery should be considered if the causative organism is Staphylococcus aureus, which often results in large vegetations, massive valve destruction, and embolic manifestations [14]. Remadi et al. reported that early surgery was associated with reduced mortality in Staphylo-

Taghavi et al. compared the outcomes between surgical management and medical treatment for tricuspid valve endocarditis [16]. They found that patients treated surgically had clear blood cultures sooner, defervesced earlier, and demonstrated a complete resolution of vegetations. They concluded that the early surgery is warranted for patients with tricuspid valve endocarditis when they are bacteremia and/or systemically infected despite optimal medical

In contrast, Gaca et al. reviewed the surgical outcomes for isolated tricuspid valve endocarditis using the Society of Thoracic Surgeons Database, and reported that patients in the healed tricuspid valve endocarditis had lower complications rates, shorter overall length of stay, and

Akinosoglou et al. suggested that, in intravenous drug users who run a high risk of complications, vegetectomy and valve repair, avoiding artificial materials should be considered as that

Successful surgical intervention requires radical debridement of infected tissue first [4]. In case of leaflet perforation or small defects localized to one or two leaflets can be repaired by either

In case of limited infection on the posterior leaflet, bicuspid valve formation of the tricuspid valve can be performed by excising the posterior leaflet and mobilizing the anterior and septal

direct closure or patch plasty using an autologous pericardial patch [18] (Figure 1).

a trend toward lower operative mortality compared with active endocarditis [17].

complications of disease (e.g. abscess and increased vegetation size) [13].

pared with medical therapy alone (29.1 vs. 58.4%, p < 0.001).

2.3. Timing of surgery

coccus aureus infective endocarditis [15].

2.4. Tricuspid valve reconstruction

can improve late survival rate [13].

well defined.

treatment.
