Infective endocarditis of the tricuspid valve. Surgical treatment with pericardial cylinder implantation.

Abstract

Introduction: Infective endocarditis (IE) on the tricuspid valve usually requires the complete resection of the infected tissue and implantation of a valve prosthesis.

Aim: We assumed that total elimination of artificial material and implantation of the entirely patient-derived biological material would reduce the recurrence of IE.

Material and methods: The group consisted of 7 consecutive patients who underwent implantation of a cylindrical valve created from the patient's own pericardium in the tricuspid orifice. There were only men aged 43 to 73 years. Isolated tricuspid valve reimplantation with a pericardial cylinder was performed in 2 patients. Five (71%) patients needed additional procedures. The postoperative follow-up ranged from 2 to 32 months (median: 17 months).

Results: In patients who underwent isolated tissue cylinder implantation, the average extracorporeal circulation (ECC) time was 77.5 minutes and aortic cross-clamp time was 58 minutes. In cases where additional procedures were performed the ECC and X-clamp times were 197.4 and 156.2 minutes, respectively. The function of the implanted valve was examined after weaning from the ECC by transesophageal echocardiogram, followed by transthoracic echocardiogram on day 5-7 after surgery revealed normal function of the prosthesis in all patients. There was no operative mortality. Two late deaths were observed.

Conclusions: In the follow-up period none of the patients had a recurrence of IE within the pericardial cylinder. Degeneration with subsequent stenosis of the pericardial cylinder occurred in 3 patients. One patient was reoperated on; one had a transcatheter valve-in-valve cylinder implantation.