Abstract
The surgical incidence of right-sided infective endocarditis (RSIE) has increased dramatically during the opioid epidemic as the rate of intravenous heroin use has more than doubled. Surgery is indicated for the treatment of RSIE when an appropriate course of antibiotic therapy fails to eliminate bacteremia, vegetation diameter exceeds 2centimeters, or tricuspid regurgitation precipitates heart failure. Three main surgical approaches exist for RSIE: valvectomy, valve repair, and valve replacement. Valve repair is the preferred technique because it restores tricuspid valve competence using a minimal amount of prosthetic material, which especially in intravenous drug users can serve as a nidus for recurrent endocarditis. If damage from vegetations is too extensive for repair, valve replacement can be performed with either a bioprosthetic or mechanical valve. Surgical management of RSIE prioritizes effective use of echocardiography preoperatively, preparedness for worsening hemodynamic status intraoperatively, and anticipation of heart block postoperatively.
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