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Percutaneous Mechanical Aspiration vs Valve Surgery for Tricuspid Valve Endocarditis in People Who Inject Drugs. | LitMetric

Percutaneous Mechanical Aspiration vs Valve Surgery for Tricuspid Valve Endocarditis in People Who Inject Drugs.

Ann Thorac Surg

Department of Internal Medicine, University of Tennessee Medical Center, Knoxville, Tennessee; Division of Infectious Diseases, Graduate School of Medicine, University of Tennessee Health Science Center, Knoxville, Tennessee. Electronic address:

Published: May 2021

AI Article Synopsis

  • - The study compares outcomes of two treatments, percutaneous mechanical aspiration (PMA) and valve surgery, for tricuspid valve infective endocarditis (TVIE) in people who inject drugs (PWID), exploring concerns about reinfection risks associated with surgery.
  • - Among 85 PWID patients (42 with PMA and 43 with surgery), there were no significant differences in 12-month mortality rates (24% for PMA vs. 19% for surgery) or in-hospital deaths, indicating that both treatments yield similar outcomes.
  • - The findings suggest that PMA could be a viable alternative to valve surgery, possibly serving as a temporary solution while PWID undergo addiction treatment.

Article Abstract

Background: Valve surgery in tricuspid valve infective endocarditis (TVIE) is controversial in people who inject drugs (PWID) due to perceived risks of reinfection because of recidivism. The study objective was to compare outcomes of percutaneous mechanical aspiration (PMA) using the Penumbra Indigo system to valve surgery in PWID with TVIE.

Methods: Retrospective cohort of adult PWID hospitalized with definite TVIE and received PMA or valve surgery from January 2014 to April 2019. Primary endpoint was all-cause 12-month mortality; secondary endpoints included in-hospital mortality and all-cause 12-month readmission.

Results: In total, 85 patients were included: 42 undergoing PMA and 43 undergoing valve surgery. Baseline patient demographics were similar between groups; 62 (73%) patients were women, and the median age was 31 (interquartile range, 27-41) years. Seventy-four (86%) patients had a previous history of infective endocarditis and received long-term antibiotic therapy before surgical intervention; 33 (38%) patients presented with septic shock on admission. The most commonly organism was methicillin-resistant Staphylococcus aureus (n = 32 of 84, 38%). Five (12%) PMA patients died in hospital compared with 1 (2%) patient who received valve surgery (P = .11). All-cause 12-month mortality was 24% and 19% for the PMA and surgery groups, respectively (P = .57). When considering confounders, there was no difference in all-cause 12-month mortality between the PMA and valve surgery groups (adjusted odds ratio, 1.5; 95% confidence interval, 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 TVIE in PWID. PMA may be an alternative to valve surgery as a treatment or bridging strategy to surgery while PWID undergo addiction treatment.

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Source
http://dx.doi.org/10.1016/j.athoracsur.2020.08.036DOI Listing

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