Abstract 14189: Isolated Tricuspid Valve Surgery Repair versus Replacement for Infective Endocarditis: A Nationwide Analysis

Abstract

Introduction: Incidence of right-sided infective endocarditis (IE) is on rise secondary to opioid epidemic, and increasing use of cardiac devices, central catheters, or AV fistulas. We aimed to compare outcomes of isolated tricuspid valve (TV) repair versus replacement and determine the predictors of mortality after isolated TV surgery for hospitalizations with IE. Methods: We utilized nationwide readmission database (NRD) to identify hospitalizations for IE that underwent isolated TV repair or replacement in 2018. Hospitalizations with concomitant or previous cardiac surgery were excluded. Multivariate logistic regression analysis was performed to determine predictors of mortality after isolated TV surgery for IE. Results: 1463 hospitalizations were identified for IE undergoing either isolated TV repair (n=531, 36.3%) or replacement (n=932, 63.7%). 106 (11.3%) underwent mechanical TV replacement. Patients undergoing TV replacement had increased risk of acute kidney injury (aOR: 1.45 (1.03-2.03), p=0.03) and pacemaker implantation (aOR: 7.03 (3.95-13.45), p<0.001), however there were no significant differences in in-hospital mortality (aOR: 0.80 (0.35-1.83), p=0.59) (Table). Independent predictors of mortality for TV replacement were advanced liver disease (ALD) (5.31 (1.62-17.67), p=0.005), and acute heart failure (3.48 (1.02-18.14), p=0.044) and for TV repair were ALD (5.72 (1.31-24.90), p=0.017), and age (1.07 (1.02-1.14), p=0.026). However, predisposing conditions (drug use, infection of cardiac prosthesis, or vascular device), micro-organisms, and mechanical TV replacement were not associated with mortality in patients undergoing surgery. Conclusions: Our study reinforces that TV repair should be preferred over replacement for right sided IE when feasible, and adds to existing literature that it is the patient’s co-morbidities rather than the predisposing factors or microbiology that is associated with increased mortality.