Abstract 12690: Outcomes of Tricuspid Valve Surgery in Patients With Septic Pulmonary Embolism From Drug-Associated Tricuspid Valve Endocarditis

Abstract

Introduction: Septic pulmonary emboli (PE) are a common sequela of drug-use associated infective endocarditis (DU-IE) of the tricuspid valve and is considered an indication for surgery. Methods: The Healthcare Cost and Utilization Project’s National Inpatient Sample was queried from 2008-2017 for adult patients hospitalized for septic PE with the diagnosis of DU-IE of the tricuspid valve. In-hospital outcomes of patients who underwent tricuspid valve operation (TVO) were compared with patients who did not. The primary outcome was perioperative major adverse cardiovascular events (MACE) defined as a composite of death, myocardial infarction (MI), stroke, cardiogenic shock, and cardiac arrest. Results: A total of 6,758 cases of DU-IE with septic PE were identified (mean age 32.2), of which 2,262 (33.6%) had a TVO during hospital admission. Patients who underwent a TVO had longer length of stay (32.3 vs 17.7, p<0.05), higher hospital costs ($97,486 vs $34,728, p<0.05), and more discharges to a long-term facility (33.7% vs 27.9%, p<0.05). MACE was significantly higher in patients undergoing TVO (12.5% vs 7.1%, p<0.05), which was driven by higher rates of stroke (5.0% vs 2.7%, p<0.05) and cardiogenic shock (4.8% vs 0.8%, p<0.05) but notably, a lower rate of mortality (2.0% vs 4.0%, p<0.05). In addition, patients who underwent TVO had more pulmonary complication (49.0% vs 29.5%, p<0.05), acute kidney injury (44.3% vs 34.0%, p<0.05), permanent pacemaker placement (15.0% vs 0.2%, p<0.05), and tracheostomy (3.7% vs 1.8%, p<0.05). After multivariable adjustment, TVO was associated with an increased risk for MACE (aOR=1.55, 95% CI 1.25 - 1.86). Conclusion: The utility of surgical intervention remains controversial given the lower rate of mortality, but higher rate of adverse outcomes in this young patient population. Alternative management strategies including percutaneous intervention should be considered given the morbidity associated with this disease presentation.