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Chick W, Alkhalil M, Egred M, Gorog DA, Edwards R, Das R, Abdeldayem T, Ibrahim O, Malik I, Mikhail G, Zaman A, Farag M. A Systematic Review and Meta-Analysis of the Clinical Outcomes of Isolated Tricuspid Valve Surgery. Am J Cardiol 2023; 203:414-426. [PMID: 37531685 DOI: 10.1016/j.amjcard.2023.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2023] [Revised: 05/20/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023]
Abstract
Patients with isolated tricuspid valve (TV) disease have poor prognosis with no consensus on their management. Transcatheter TV intervention is emerging as a valid option in patients with prohibitive surgical risk. We analyzed studies of patients who underwent isolated TV surgery to identify the features associated with successful clinical outcomes. We performed a systematic review and meta-analysis of studies reporting clinical outcomes of isolated surgical TV intervention, namely TV repair, TV replacement with a bioprosthetic valve (TVR-B), or TV replacement with a mechanical valve (TVR-M). Twenty-seven studies involving 10,478 patients (4,931 TV repair, 3,821 TVR-B, and 1,713 TVR-M) were included. Early mortality occurred in 9% and did not differ between TV surgical approaches. Late mortality was 27% at a median follow-up of 4 (3 to 6) years and was significantly higher for all-TVR (30% vs 25%, rate ratio 1.18, 95% confidence interval 1.05 to 1.31, p = 0.004) and TVR-B (28% vs 24%, rate ratio 1.15, 95% confidence interval 1.02 to 1.30, p = 0.02) compared with TV repair. Late mortality did not differ between TVR-B and TVR-M. Across all studies, early complications included bleeding (7.4%), acute kidney injury (18.7%), permanent pacemaker (13.7%), cerebrovascular accidents (1.2%), and infection (8.9%). Late clinical outcomes included reintervention (3.7%), structural valve deterioration (2.4%), valve thrombosis (2.6%), and TV regurgitation recurrence after 1 year (15.0%). In conclusion, in isolated TV surgeries, TV repair has favorable long-term mortality compared with TV replacement. This supports the development and refinement of transcatheter TV repair approaches. Future research is recommended to provide comparative data for various transcatheter TV interventions.
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Affiliation(s)
- William Chick
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Mohammad Alkhalil
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom.
| | - Mohaned Egred
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Diana A Gorog
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom; Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, United Kingdom
| | - Richard Edwards
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Rajiv Das
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom
| | - Tarek Abdeldayem
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Osama Ibrahim
- Cardiology Department, Lister Hospital, East and North Hertfordshire NHS Trust, Hertfordshire, United Kingdom
| | - Iqbal Malik
- Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Ghada Mikhail
- Postgraduate Medical School National Heart and Lung Institute, Imperial College London, London, United Kingdom; Cardiology Department, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Azfar Zaman
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Translational and Clinical Research Institute, Newcastle University, Newcastle-upon-Tyne, United Kingdom
| | - Mohamed Farag
- Cardiothoracic Department, Freeman Hospital, Newcastle-upon-Tyne, United Kingdom; Health Services and Clinical Research, Postgraduate Medical School, University of Hertfordshire, United Kingdom.
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2
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Scotti A, Sturla M, Granada JF, Kodali SK, Coisne A, Mangieri A, Godino C, Ho E, Goldberg Y, Chau M, Jorde UP, Garcia MJ, Maisano F, Bapat VN, Ailawadi G, Latib A. Outcomes of isolated tricuspid valve replacement: a systematic review and meta-analysis of 5,316 patients from 35 studies. EUROINTERVENTION 2022; 18:840-851. [PMID: 36197445 PMCID: PMC10167545 DOI: 10.4244/eij-d-22-00442] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2022] [Accepted: 08/17/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND Transcatheter tricuspid valve replacement (TTVR) is rapidly emerging as a therapeutic option amongst patients with secondary tricuspid regurgitation. Historical data from surgical tricuspid valve replacement (TVR) studies may serve as a benchmark for the development of TTVR trials. AIMS The aim of the study was to investigate the early and late outcomes following isolated surgical TVR. METHODS Multiple electronic databases were searched to identify studies on isolated surgical TVR. The prespecified primary endpoint was operative mortality; secondary endpoints were early and late outcomes. Overall estimates of proportions and incidence rates with 95% confidence intervals (CI) were calculated using random-effects models. Multiple sensitivity analyses accounting for baseline characteristics, country and the operative period were applied. Results: A total of 35 studies (5,316 patients) were included in this meta-analysis. The operative period ranged from 1974 to 2019. The overall rate of operative mortality was 12% (95% CI: 9-15), with higher mortality for patients who were operated on before 1995, who had prior cardiac surgeries, or who had liver disease. The most frequent clinical events were pacemaker implantation (10% [95% CI: 6-16]), bleeding (12% [95% CI: 8-17]), acute kidney injury (15% [95% CI: 9-24]) and respiratory complications (15% [95% CI: 12-20]). At follow-up analysis of the bioprosthetic TVR, there was an incidence rate per 100 person-years of 6 (95% CI: 2-13) for death and 8 (95% CI: 5-13) for recurrence of significant tricuspid regurgitation. CONCLUSIONS This meta-analysis provides an overview of the historical clinical outcomes following isolated surgical TVR. These findings can support the development of future clinical trials in the tricuspid space by providing thresholds for clinical outcomes.
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Affiliation(s)
- Andrea Scotti
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Matteo Sturla
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Juan F Granada
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Susheel K Kodali
- Division of Cardiology, New York-Presbyterian Hospital/Columbia University Irving Medical Center, New York, NY, USA
| | - Augustin Coisne
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
- Cardiovascular Research Foundation, New York, NY, USA
| | - Antonio Mangieri
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy and Cardio Center, Humanitas Research Hospital IRCCS, Rozzano, Italy
| | - Cosmo Godino
- Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Edwin Ho
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ythan Goldberg
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mei Chau
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Ulrich P Jorde
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Mario J Garcia
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Vinayak N Bapat
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Gorav Ailawadi
- Department of Cardiac Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Azeem Latib
- Montefiore-Einstein Center for Heart and Vascular Care, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
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Low ZM, Krishnaswamy S, Woolley IJ, Stuart RL, Boers A, Barton TL, Korman TM. Burden of infective endocarditis in an Australian cohort of people who inject drugs. Intern Med J 2021; 50:1240-1246. [PMID: 31841254 DOI: 10.1111/imj.14717] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2019] [Revised: 11/21/2019] [Accepted: 12/08/2019] [Indexed: 11/26/2022]
Abstract
BACKGROUND Infective endocarditis (IE) results in substantial morbidity and mortality in people who inject drugs (PWID). AIMS To describe the burden of IE and its outcomes in PWID. METHODS Retrospective cohort study of adults admitted to a tertiary referral centre in Melbourne, Australia, with IE due to injection drug use from 1997 to 2015. RESULTS Ninety-seven PWID with 127 episodes of IE were identified with a median acute inpatient stay of 37 days (1-84). Admission to an intensive care unit was required in 67/127 (53%) episodes. Twenty-seven percent (34/127) of episodes occurred in patients with a previous episode of endocarditis. One third (43/127, 34%) of episodes involved left-sided cardiac valves. Antimicrobial treatment was completed in 88 (70%) episodes. Valve surgery was performed in 25/127 (20%) episodes. Predictors of surgery in univariable analysis were left-sided cardiac involvement (risk ratio (RR) 6.0), severe valvular regurgitation (RR 2.6) and cardiac failure (RR 2.2) (all P < 0.005). Twenty (16%) episodes resulted in death. Predictors of mortality on univariable analysis were left-sided cardiac involvement (RR 6.4), and not completing treatment (RR 0.12; both P < 0.001). The average estimated cost per episode was AU$74 168. CONCLUSIONS IE causes a considerable burden of disease in PWID, with significant healthcare utilisation and cost. Surgery and death are not infrequent complications. In addition to ensuring completion of antimicrobial therapy, strategies such as opioid maintenance programmes may be useful in improving health outcomes for PWID.
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Affiliation(s)
- Zhi M Low
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia
| | | | - Ian J Woolley
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Rhonda L Stuart
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Melbourne, Victoria, Australia
| | - Anthony Boers
- Department of General Medicine, Latrobe Regional Hospital, Traralgon, Victoria, Australia
| | - Timothy L Barton
- Monash Cardiovascular Research Centre, Monash Heart, Monash Health, Melbourne, Victoria, Australia.,Department of Medicine, School of Clinical Sciences at Monash Health, Monash University, Melbourne, Victoria, Australia
| | - Tony M Korman
- Monash Infectious Diseases, Monash Health, Melbourne, Victoria, Australia.,Centre for Inflammatory Diseases, Department of Medicine, Monash University, Melbourne, Victoria, Australia
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Yanagawa B, Elbatarny M, Verma S, Hill S, Mazine A, Puskas JD, Friedrich JO. Surgical Management of Tricuspid Valve Infective Endocarditis: A Systematic Review and Meta-Analysis. Ann Thorac Surg 2018; 106:708-714. [PMID: 29750928 DOI: 10.1016/j.athoracsur.2018.04.012] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/15/2018] [Revised: 03/31/2018] [Accepted: 04/02/2018] [Indexed: 01/24/2023]
Abstract
BACKGROUND This meta-analysis compares the early and late outcomes of valve repair versus replacement, the primary surgical strategies for tricuspid valve infective endocarditis (IE). METHODS We searched MEDLINE and EMBASE databases until 2016 for studies comparing tricuspid valve repair and replacement. RESULTS The main outcomes were mortality, recurrent IE, and need for reoperation. There were 12 unmatched retrospective observational studies with 1,165 patients (median follow-up 3.8 years, interquartile range: 2.1 to 5.0). The most common indications for surgery were septic pulmonary embolism, left-sided IE, right-side heart failure, and persistent bacteremia. Median repair proportion was 59% and replacement was 41% among studies. The primary repair strategies are vegetectomy, De Vega procedure, annuloplasty ring, bicuspidization, and leaflet patch augmentation. Of valve replacements, 83% were bioprosthetic and 17% mechanical prostheses. There were no differences in perioperative mortality between tricuspid valve repair versus replacement (relative risk [RR] 0.62, 95% confidence interval [CI]: 0.26 to 1.46, p = 0.3). Long-term all-cause mortality was not different (RR 0.61, 95% CI: 0.22 to 1.72, p = 0.4). Valve repair was associated with lower recurrent IE (RR 0.17, 95% CI: 0.05 to 0.57, p = 0.004) and need for reoperation (RR 0.26, 95% CI: 0.07 to 0.92, p = 0.04) but a trend toward greater risk of moderate to severe tricuspid regurgitation (RR 4.14, 95% CI: 0.80 to 21.34, p = 0.09). Furthermore, tricuspid valve repair is associated with lower need for permanent pacemaker (RR 0.20, 95% CI: 0.11 to 0.35, p < 0.001). CONCLUSIONS Tricuspid valve repair and replacement offer similar long-term survival. Valve repair may offer greater freedom from recurrent IE and reoperation as well as freedom from pacemaker and should be the preferred approach for patients with tricuspid valve IE.
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Affiliation(s)
- Bobby Yanagawa
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
| | - Malak Elbatarny
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Subodh Verma
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Samantha Hill
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - Amine Mazine
- Division of Cardiac Surgery, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John D Puskas
- Department of Cardiothoracic Surgery, Mount Sinai Hospital, New York, New York
| | - Jan O Friedrich
- Department of Critical Care and Medicine, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
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Shetty N, Nagpal D, Koivu S, Mrkobrada M. Surgical and Medical Management of Isolated Tricuspid Valve Infective Endocarditis in Intravenous Drug Users. J Card Surg 2015; 31:83-8. [DOI: 10.1111/jocs.12682] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Affiliation(s)
- Nabha Shetty
- Department of Medicine; Dalhousie University; Halifax Nova Scotia
| | - Dave Nagpal
- Division of Cardiac Surgery and Intensive Care; Western University; London Ontario
| | - Sharon Koivu
- Division of Palliative Care; Western University; London Ontario
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Yong MS, Coffey S, Prendergast BD, Marasco SF, Zimmet AD, McGiffin DC, Saxena P. Surgical management of tricuspid valve endocarditis in the current era: A review. Int J Cardiol 2015; 202:44-8. [PMID: 26386918 DOI: 10.1016/j.ijcard.2015.08.211] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2014] [Revised: 03/02/2015] [Accepted: 08/26/2015] [Indexed: 11/29/2022]
Abstract
The incidence of isolated tricuspid valve infective endocarditis is increasing. Medical management is the mainstay of treatment but surgical intervention is required in a subset of patients. Surgical treatment options include valve excision and replacement or valve reconstruction. We searched PubMed and the Cochrane library to identify articles to be included in this review of surgical outcomes. References of selected articles were crosschecked for other relevant studies. Surgical management of tricuspid valve endocarditis can be achieved with satisfactory outcomes. However, the optimal indication and timing of surgery remain unclear, and the frequent association with intravenous drug use complicates management. Repair techniques are preferable though there is no clear evidence supporting one method over another.
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Affiliation(s)
- Matthew S Yong
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Sean Coffey
- Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Bernard D Prendergast
- Department of Cardiology, Oxford University Hospitals NHS Trust, Oxford, United Kingdom
| | - Silvana F Marasco
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Adam D Zimmet
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - David C McGiffin
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia
| | - Pankaj Saxena
- Department of Cardiothoracic Surgery, The Alfred Hospital, Melbourne, Australia.
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Affiliation(s)
- Hassina Baraki
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School
| | - Shunsuke Saito
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School
| | - Ammar Al Ahmad
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School
| | - Bernhard Fleischer
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School
| | - Axel Haverich
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School
| | - Ingo Kutschka
- Department of Cardiac-, Thoracic-, Transplantation and Vascular Surgery, Hannover Medical School
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Marcano Sanz L, Naranjo Ugalde A, González Guillén A, Bermúdez Gutiérrez G, Frías Griskho F. [Infective fungal endocarditis in patients with no previous cardiac disease]. An Pediatr (Barc) 2012; 78:113-7. [PMID: 22841655 DOI: 10.1016/j.anpedi.2012.01.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2011] [Revised: 01/04/2012] [Accepted: 01/16/2012] [Indexed: 11/28/2022] Open
Abstract
Infective endocarditis is a serious and uncommon condition affecting the endocardium. Less than 10% of these cases are of fungal origin. A growing number of individuals are at high risk, due to insertion of central venous catheters, total parenteral nutrition and prolonged exposure to broad-spectrum antibiotics, even without previous heart diseases. We retrospectively analysed the records of six children with Candida endocarditis, reviewing the comorbidities, clinical outcome, and treatment. The antifungal agents used were amphotericin B, 5-fluorocytosine and fluconazole. Patients underwent surgical excision of vegetation, five tricuspid valve repairs and one mitral valve replacement. There were no hospital deaths, and one child needed a new valvuloplasty one year later. The mean follow up was five years, and all have good valvular function without recurrent endocarditis. A combination of synergistic long-term antifungal treatment and early surgical intervention is recommended.
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Affiliation(s)
- L Marcano Sanz
- Servicio de Cirugía Cardiovascular, Cardiocentro Pediátrico William Soler, La Habana, Cuba.
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