Isolated Tricuspid Valve Replacement for Severe Infective Endocarditis: Beating Heart versus Arrested Heart Author:

Objective prospective evaluation of the technique of isolated tricuspid valve replacement on beating heart, compared to the classic aortic cross clamp and cardiolplegia administration. Methods Between May 2004 and May 2014, 30 patients underwent surgery for isolated tricuspid valve infective endocarditis (TVIE), in Cairo University hospitals. Patients were divided into two equal groups. 15 patients had TV replacement on beating heart (Group A), while the other 15 patients had TV replacement on arrested heart and cardiolplegia administration (Group B). Patients were followed for 3 months postoperatively regarding recurrence of endocarditis and conduction abnormalities. Results Operative mortality was 13.3% in group A versus 20% in group B. The mean ischemic time for group B was 43.86±9.13 min. Bypass time was insignificantly shorter in group A (71.26±7.88 min versus 87.93±8.25 min). 26.6% of patients needed inotropic support in group B versus 26.6% in group A. (p=0.028). Atrioventricular block occurred in 13.3% of patients in group A versus 53.3% in group B ( p=0.025). There was no recurrence of infection, new onset of heart block or thrombembolic events during the follow up. Conclusion Tricuspid valve replacement on beating heart was superior regarding the incidence of temporary AV block, and the need for inotropic support. However, permanent pacemaker implantation, bypass time and mortality were comparable.