Outcome of Percutaneous and Surgical Management for Tricuspid Infective Endocarditis: Insights From a National Study

Abstract

Background

The prevalence of infective endocarditis (IE) and its associated mortality rates remain high, despite medical advances. In recent years, treatment options for IE have expanded, but they are yet to be widely utilized. The current study aimed to compare in-hospital outcomes of high-risk tricuspid valve (TV) IE patients, by treatment strategy.

Methods

Patients from the National Inpatient Sample 2017-2019 database who had TV IE were grouped by therapy type—percutaneous aspiration, surgical, or conservative management. Patients were considered to be at high risk if they underwent mechanical intervention or if they had right ventricle failure or septic emboli.

Results

The analyzed cohort consisted of 28,495 patients—1.7% were treated with percutaneous aspiration, 13.5% with surgery, and 84.6% conservatively. Patients treated with percutaneous aspiration had the highest prevalence of septic shock and acute respiratory failure (P < 0.001). The overall in-hospital mortality rate was 7%. Patients treated conservatively had higher in-hospital mortality rates (7.5%) compared to those of the surgical group (4.4%) and the percutaneous aspiration group (4.1%; P < 0.001). In a multivariate analysis, conservative management was associated with an increased risk of in-hospital mortality (odds ratio 2.853, 95% confidence interval 1.748-4.659, P < 0.001), and no significant difference was found between the aspiration and surgical groups (P = 0.346). Benefits were pronounced in younger patients and those with septic shock or respiratory failure. Patients in the aspiration group had the highest rate of home discharge with self-care, of the various patient dispositions (P < 0.001).

Conclusions

Among high-risk patients with TV IE, an invasive approach is associated with a significantly lower in-hospital mortality rate than is a conservative approach, particularly in younger and unstable patients.