**Abstract**

Tricuspid valve endocarditis (TVE) continues to be on the rise and has been mostly attributed to the growing epidemic of intravenous drug abuse (IVDA). Other risk factors include long-term indwelling central venous catheters and implantable cardiac devices. While medical management continues to be the first line therapy, surgery is indicated when medical management fails, and in the presence of hemodynamic deterioration, recurrent septic pulmonary embolization and/or persistent sepsis. Tricuspid valve (TV) excision once was the main surgical strategy, but other options include TV repair/reconstruction and replacement. Remaining challenges include management of drug-induced endocarditis and the best strategy for recurrent infection.

**Keywords:** endocarditis, tricuspid valve endocarditis, intravenous drug abuse, implantable cardiac devices

### **1. Introduction**

Infective endocarditis remains a serious disease that is associated with significant morbidity and mortality. The overall incidence is relatively low, about 5/100,000 person-years [1]. In the current era, aggressive medical therapy and earlier surgical interventions with few exceptional circumstances have been the goal. Recent literature shows relatively stable mortality rates, despite the improvement in diagnostic and therapeutic tools including medical therapy and surgical techniques [2]. Isolated TVE overall is less common in comparison to left sided endocarditis. In a study of 801 adult patients with endocarditis, tricuspid or multivalvular involvement was present in 31.2% and this was a significant risk factor of early mortality on multivariate analysis [3]. The incidence of TVE is increasing, mostly related to the growing epidemic of drug abuse. In the report by Seratnahaei et al., the incidence of tricuspid endocarditis increased from 6% between 1999 and 2000 to 36% between 2009 and 2010 [4].

## **2. Epidemiology**

Right-sided endocarditis occurs at lower incidence in comparison to left-sided infection due to the less common pathology that involves the right heart in addition to the lower pressures and decrease oxygen content in comparison to the left side of the heart [5].

Right-sided endocarditis represents 5–10% of infective endocarditis cases [6], and TVE constitutes the majority of these cases. Of all surgeries for endocarditis in North America, 4.1% involves TVE [7].
