Substance use disorder-associated tricuspid endocarditis: Staged surgery from valvectomy to replacement.
- 1Department of Cardiovascular and Thoracic Surgery, University of Louisville, Louisville, Ky.
Abstract
Objectives
Optimal surgical treatment of infective tricuspid infective endocarditis (TVIE) is controversial in the setting of active substance use. This study evaluated patients who had endocarditis that was not amenable to tricuspid valve repair. In these patients, a valvectomy was performed to remove the diseased tissue. Patients were then offered a subsequent tricuspid valve replacement after proper follow-up and drug abstinence.Methods
A single-center database was queried (2015-2025) to identify adults who underwent valvectomy for TVIE not amenable to repair after failed medical therapy and persistent positive blood cultures. Patients who underwent valvectomy with documented intravenous drug abstinence for 6 months were considered for staged tricuspid valve replacement (sTVR). Patients with persistent drug use did not receive further surgical treatment. Baseline characteristics, outcomes, and survival were evaluated.Results
In total, 153 patients underwent surgical treatment for TVIE. Tricuspid valvectomy was required in 51 patients. Of the patients, 66% were female, with a median age of 30 years. There were 2 operative mortalities (3.9%). The 1-, 5-, and 8-year survival was 91%, 62%, and 51%, respectively; 26 (51%) received an sTVR and 25 (49%) did not receive sTVR (non-sTVR). In those that received an sTVR, there were 0 operative mortalities, median postoperative length of stay was 6 days, and median hours in the intensive care unit was 30. Intravenous drug use relapse after sTVR was present in 57.7% of patients. Survival at 1 and 5 years after the sTVR was 100% and 60%.Conclusions
Tricuspid valvectomy is an acceptable initial treatment in high-risk patients. Tricuspid valve replacement after completing an abstinence program from intravenous drugs for 6 months has acceptable outcomes in a complex patient population. Further study of long-term outcomes is warranted.
Related
- Robotic tricuspid valve repair for infective endocarditis with leaflet perforation and severe tricuspid regurgitation
- Invasive Complications and Infection-Related Reconstruction in Bicuspid Versus Tricuspid Native Aortic Valve Endocarditis: A 12-Year Surgical Cohort Study
- From Heart Murmur to Bone Involvement: Tricuspid Valve Endocarditis With First-Rib Osteomyelitis in a Patient With Methicillin-Resistant Staphylococcus aureus (MRSA) Bacteremia
- Tricuspid Valve Infective Endocarditis Seen on Point-of-Care Ultrasound: A Case Report
- A Novel Technique Using Flash 2.0 Catheter for Percutaneous Aspiration of Native Tricuspid Valve Endocarditis Caused by a Hemodialysis Venous Catheter
BibTeX
@article{crane2026substance,
title = {{Substance use disorder-associated tricuspid endocarditis: Staged surgery from valvectomy to replacement.}},
author = {Joshua G Crane and Toyokazu Endo and Jaimin R Trivedi and Brian L Ganzel and Sharini Shah and Siddharth V Pahwa and Mark S Slaughter and Michele Gallo},
journal = {JTCVS open},
year = {2026},
month = jul,
doi = {10.1016/j.xjon.2026.101957},
url = {https://europepmc.org/article/MED/42948116},
note = {CC BY},
}
RIS
TY - JOUR
TI - Substance use disorder-associated tricuspid endocarditis: Staged surgery from valvectomy to replacement.
AU - Joshua G Crane
AU - Toyokazu Endo
AU - Jaimin R Trivedi
AU - Brian L Ganzel
AU - Sharini Shah
AU - Siddharth V Pahwa
AU - Mark S Slaughter
AU - Michele Gallo
PY - 2026
DA - 2026/07/10
JO - JTCVS open
DO - 10.1016/j.xjon.2026.101957
UR - https://europepmc.org/article/MED/42948116
AB - Objectives Optimal surgical treatment of infective tricuspid infective endocarditis (TVIE) is controversial in the setting of active substance use. This study evaluated patients who had endocarditis that was not amenable to tricuspid valve repair. In these patients, a valvectomy was performed to remove the diseased tissue. Patients were then offered a subsequent tricuspid valve replacement after proper follow-up and drug abstinence.Methods A single-center database was queried (2015-2025) to identify adults who underwent valvectomy for TVIE not amenable to repair after failed medical therapy and persistent positive blood cultures. Patients who underwent valvectomy with documented intravenous drug abstinence for 6 months were considered for staged tricuspid valve replacement (sTVR). Patients with persistent drug use did not receive further surgical treatment. Baseline characteristics, outcomes, and survival were evaluated.Results In total, 153 patients underwent surgical treatment for TVIE. Tricuspid valvectomy was required in 51 patients. Of the patients, 66% were female, with a median age of 30 years. There were 2 operative mortalities (3.9%). The 1-, 5-, and 8-year survival was 91%, 62%, and 51%, respectively; 26 (51%) received an sTVR and 25 (49%) did not receive sTVR (non-sTVR). In those that received an sTVR, there were 0 operative mortalities, median postoperative length of stay was 6 days, and median hours in the intensive care unit was 30. Intravenous drug use relapse after sTVR was present in 57.7% of patients. Survival at 1 and 5 years after the sTVR was 100% and 60%.Conclusions Tricuspid valvectomy is an acceptable initial treatment in high-risk patients. Tricuspid valve replacement after completing an abstinence program from intravenous drugs for 6 months has acceptable outcomes in a complex patient population. Further study of long-term outcomes is warranted.
SN - 2666-2736
ER -