Percutaneous Mechanical Aspiration vs Valve Surgery for Tricuspid-valve Endocarditis in Drug Users.

Percutaneous Mechanical Aspiration vs Valve Surgery for Tricuspid-valve Endocarditis in Drug Users.

Ann Thorac Surg. 2020 Oct 20;:

Authors: Veve MP, Akhtar Y, McKeown PP, Morelli MK, Shorman MA

Abstract
BACKGROUND: Valve surgery in tricuspid-valve infective endocarditis is controversial in people who inject drugs (PWID) due to perceived risks of reinfection due to recidivism. The study objective was to compare outcomes of percutaneous mechanical aspiration (PMA) using the Penumbra Indigo system to valve surgery in PWID with tricuspid-valve infective endocarditis.
METHODS: Retrospective cohort of adult PWID hospitalized with definite tricuspid-valve infective endocarditis and received PMA or valve surgery from 1/2014-4/2019. Primary endpoint was all-cause 12-month mortality; secondary endpoints included in-hospital mortality and all-cause 12-month readmission.
RESULTS: 85 patients were included: 42 PMA, 43 valve surgery. Baseline patient demographics were similar between groups; 62 (73%) of patients were women, and the median (IQR) age was 31 (27-41) years. Seventy-four (86%) patients had a previous history of infective endocarditis and received long-term antibiotic therapy prior to surgical intervention; 33 (38%) patients presented with septic shock on admission. The most commonly organism was methicillin-resistant Staphylococcus aureus (32/84, 38%). Five (12%) PMA patients died in-hospital compared to 1 (2%) who received valve surgery (P=0.11). All-cause 12-month mortality was 24% and 19% for PMA and surgery groups, respectively (P=0.57). When considering confounders, there was no difference in all-cause 12-month mortality between PMA and valve surgery groups (adjOR, 1.5; 95%CI, 0.48-4.8); no significant differences in secondary outcomes were identified.
CONCLUSIONS: PMA was associated with similar outcomes to valve surgery for management of TVE in PWID. PMA may be an alternative to valve surgery as a treatment or bridging strategy to surgery while PWID undergo addiction treatment.

PMID: 33096075 [PubMed - as supplied by publisher]