Tricuspid Valve Endocarditis, a Single Center Experience to Reduce the Chance of Atrioventricular Block

Background: Tricuspid Valve Endocarditis (TVE) in Intravenous Drug Abusers (IVDAs) is one of the leading causes of disability as it entails both cardiovascular and neurological complications which eventually usher in socioeconomic problems. The most practical approach is debated given variables such how to manage patients with elevated pulmonary artery pressures, what type of prosthetic valve to employ, how to mitigate the risk of post-operative reinfection, and strategies to reduce the possibility of development of Atrioventricular (AV) block. In this study, we present a novel technique for valve replacement to reduce or altogether eliminate the chance of developing AV block. Methods: Between December 2003 to November 2013, 243 consecutive patients with tricuspid valve endocarditis were enrolled in this study. This study was conducted in Imam Khomeini Hospital Complex, Tehran University of Medical Sciences. After January 2007 and whenever the septal leaflet was destroyed, and repair was not feasible, we sewed a double layer strip of pericardium along the septal leaflet annulus to make an anchoring cuff for Tricuspid Valve Replacement (TVR) stitches. The primary end point of this study was to compare the frequency of AV block following valve replacement before and after application of our novel technique. Results: All-cause mortality was in 27 (11.1%) patients. AV block was seen in 11 (22.9%) patients who underwent TVR. Mean survival in TVR patients with sinus rhythm after operation was 39.2 ± 4 months and in patients with AV block was 2.9 ± 1.2 months, (p-value: .000). In logistic regression analysis, developing AV block on the technique of TVR was statistically significant. Conclusion: In our findings, whenever resection of destroyed septal leaflet is inevitable, utilizing our novel technique of TVR is a practical strategy to reduce or altogether abolish the chance of developing AV block. Keywords: Tricuspid valve; Endocarditis; Drug abuser; Outcome study; Atrioventricular bloc