Trends in Utilization of Percutaneous Tricuspid Valve Vegetation Debulking in Patients With Infective Endocarditis 2017-2019

Author Type(s)

Faculty, Resident/Fellow

Document Type

Abstract

Publication Date

3-7-2023

Journal Title

Journal of the American College of Cardiology

Department

Medicine

Abstract

Background

Right-sided endocarditis accounts for 5-10% of all infective endocarditis (IE) patients. The tricuspid valve is involved in 90% of these patients. The vacuum-based device got approval in 2014 for the percutaneous removal of undesirable materials from the intravascular system. Despite more recent increased utilization of this device, there is limited data on its outcomes at a national and multicenter level.

Methods

Data was extracted from NRD databases from 2017 to 2019 with the appropriate ICD-10 codes (infective endocarditis: ICD-10-CM I33x, I38x, and I39x; extirpation of matter from the tricuspid valve, percutaneous approach: ICD-10 02CJ3ZZ procedure code).

Results

A total of 255,301 patients with endocarditis were identified from 2017-2019. Amongst these 436 patients underwent percutaneous extirpation of materials from the tricuspid valve. Procedural success, defined as the lack of requirement of tricuspid valve surgery, was 88.8%. The median age of patients with IE who underwent debulking of the tricuspid valve was 35.0 yrs. (IQR 29-49), 55.8% of these patients were female. The prevalence of clinical comorbidities among patients who underwent debulking were alcohol or drug abuse 75.3%, hypertension 32.6%, diabetes mellitus 17%, arrhythmias 35.2%, chronic pulmonary disease 14.4%, peripheral vascular disease 8.6%, liver disease 22.6%, chronic kidney disease 14.2%. In terms of complications, in patients who had debulking among them, 47% of patients had acute kidney injury, 17.3% were mechanically ventilated, 5.0% had ECMO, 1.0% had IABP, 1.4% had cardiac arrest, 5.0% developed cardiogenic shock, and 4% died in hospital. Patients who underwent debulking witnessed a readmission rate of 16.4% in a 30-day period.

Conclusion

Our analysis is the first national multicenter report on the tricuspid valve debulking procedure. Right-sided tricuspid valve debulking procedures in patients with endocarditis are a viable option and have increasingly been utilized with a nearly 90% success rate. Its use has gradually been increasing in the United States and offering an alternative treatment option, especially in patients with recurrent endocarditis with a history of drug use.

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