Avoiding the Pump in Tricuspid Valve Endocarditis-Vegetectomy under Inflow Occlusion

Jai Raman, MBBS, MMed, FRACS, Rinaldo Bellomo, MBBS, MD, FRACP, and Pallav Shah, MBBS, MS, MCh

Background: Surgical treatment of tricuspid valve endocarditis (TVE) ranges from vegetectomy to valve replacement with the use of cardiopulmonary bypass (CPB), accompanied by risks of systemic and lung complications. We present our experience with tricuspid valve vegetectomy under inflow occlusion without CPB.
Methods: Between July 1998 and July 2001, seven patients with a mean age of 26 years underwent tricuspid valve vegetectomy under vena caval inflow occlusion (VCIO). Five patients were intravenous drug users. None of them had left-sided heart valve involvement. The clinical indications for operating were recurrent septic pulmonary emboli with significant bilateral lung infiltrates and intractable infection with signs of severe systemic sepsis, despite treatment with appropriate intravenous antibiotics for a mean duration of 126 hours. The echocardiographic indication was very large localized >1 cm vegetations in all patients. Six patients had methicillin sensitive staphylococcus aureus and one had streptococcus viridans positive blood cultures. Five patients had postoperative high volume veno-venous hemofiltration (HVVF).
Results: There were no deaths. VCIO time did not exceed 2 minutes (range time was 45 seconds to 2 minutes). All patients had resolution of sepsis and improvement in respiratory status within 48 hours. Five patients had trivial and two moderate tricuspid regurgitation. Six patients were discharged home within 14 days with no long-term sequelae. One patient required long-term dialysis for renal failure. One patient required a late thoracotomy for drainage of a loculated empyema.
Conclusions: Tricuspid valve vegetectomy can be performed safely under VCIO. HVVF promotes removal of inflammatory mediators, thus improving recovery. (Ann Thorac Cardiovasc Surg 2002; 8: 350-350)

Key words: tricuspid valve, endocarditis, inflow occlusion

From Department of Cardiac Surgery and Intensive Care, Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, Australia

Received July 15, 2002; accepted for publication October 7, 2002
Address reprint requests to Jai Raman, MBBS, MMed, FRACS: Department of Cardiac Surgery, Austin and Repatriation Medical Centre, University of Melbourne, Heidelberg, Victoria 3084, Australia. Presented at the Cardiothoracic Techniques and Technologies Con