Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis
Background: The prevalence of tricuspid valve (TV) infective endocarditis (IE) continues to increase among patients with drug addictions and chronic vascular access or cardiac electronic devices. Moreover, long-term mortality and morbidity following surgery with conventional prost...
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IMR Press
2025-07-01
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| Series: | Reviews in Cardiovascular Medicine |
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| Online Access: | https://www.imrpress.com/journal/RCM/26/7/10.31083/RCM37204 |
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| author | Mikhail Nuzhdin Yury Malinovsky Maksim Galchenko Roman Komarov Aleksey Fokin Nikita Nadtochiy |
| author_facet | Mikhail Nuzhdin Yury Malinovsky Maksim Galchenko Roman Komarov Aleksey Fokin Nikita Nadtochiy |
| author_sort | Mikhail Nuzhdin |
| collection | DOAJ |
| description | Background: The prevalence of tricuspid valve (TV) infective endocarditis (IE) continues to increase among patients with drug addictions and chronic vascular access or cardiac electronic devices. Moreover, long-term mortality and morbidity following surgery with conventional prostheses remain high. Allografts may represent a suitable alternative in tricuspid surgery. This study aimed to compare outcomes between stented biological valves and mitral allografts (MAs) for tricuspid valve replacement (TVR). Methods: A total of 54 patients with IE underwent TVR using either a stented bioprosthesis (B) or MA between January 2016 and July 2024. Clinical and echocardiographic data were analyzed in accordance with the Tricuspid-Valve Academic Research Consortium (T-VARC) criteria. Early safety, clinical efficacy, and time-to-event survival were compared between the two equal B and MA groups. Results: There were no in-hospital or 30-day mortality, nor cardiac, cerebral, and wound complications in either group. The peak and mean pressure gradient (PG) on TV after surgery were 9.2 (6.5–12.0) and 4.0 (3.2–6.0) mmHg in the B group versus 6.0 (4.5–7.5) and 3.0 (2.0–4.0) mmHg in the MA group (p < 0.001). A T-VARC-adjusted analysis demonstrated superior freedom from cardiovascular mortality, recurrent IE, reoperation, and permanent pacemaker implantation (PPI) in the MA group 2 years after operation. Kaplan–Meier analysis revealed significantly higher freedom from cardiovascular mortality in the MA group (100% vs. 81.5%, 77.8%, 77.8%, 69.6% respectively (log-rank test, p = 0.011) at 12-, 18-, 24-, 36-months, and freedom from PPI (100% vs. 81% at all time intervals) (log-rank test, p = 0.021). Conclusion: Application of contemporary endpoint criteria demonstrated superior outcomes with MA, including lower cardiovascular mortality, reduced PPI, fewer recurrent endocarditis, decreased reoperations, cardiac hospitalizations, alongside improved patient-reported outcomes. Time-to-event analysis demonstrated benefits in cardiovascular survival and PPI avoidance with allografts. Mitral allograft may be a preferable alternative valve substitute for TVR in patients with IE. Clinical Trial Registration: ClinicalTrials.gov ID: NCT06591000, https://clinicaltrials.gov/study/NCT06591000?term=NCT06591000&rank=1, registration date: September 19, 2024. |
| format | Article |
| id | doaj-art-462c43f5bf694bc1b1e98a7c4b496c39 |
| institution | Kabale University |
| issn | 1530-6550 |
| language | English |
| publishDate | 2025-07-01 |
| publisher | IMR Press |
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| series | Reviews in Cardiovascular Medicine |
| spelling | doaj-art-462c43f5bf694bc1b1e98a7c4b496c392025-08-20T04:02:12ZengIMR PressReviews in Cardiovascular Medicine1530-65502025-07-012673720410.31083/RCM37204S1530-6550(25)01864-2Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective EndocarditisMikhail Nuzhdin0Yury Malinovsky1Maksim Galchenko2Roman Komarov3Aleksey Fokin4Nikita Nadtochiy5Department of Cardiac Surgery, State Budgetary Healthcare Institution “Chelyabinsk Regional Clinical Hospital”, 454048 Chelyabinsk, Russian FederationDepartment of Cardiac Surgery, State Budgetary Healthcare Institution “Chelyabinsk Regional Clinical Hospital”, 454048 Chelyabinsk, Russian FederationDepartment of Applied Sciences and Data Analysis, Saint-Petersburg State Agrarian University, 196605 Saint-Petersburg, Russian FederationDepartment of Aortic and Cardio-Vascular Surgery, I.M. Sechenov First Moscow State Medical University, 119146 Moscow, Russian FederationDepartment of Surgery, South Ural State Medical University, 454092 Chelyabinsk, Russian FederationDepartment of Cardiac Surgery, State Budgetary Healthcare Institution “Chelyabinsk Regional Clinical Hospital”, 454048 Chelyabinsk, Russian FederationBackground: The prevalence of tricuspid valve (TV) infective endocarditis (IE) continues to increase among patients with drug addictions and chronic vascular access or cardiac electronic devices. Moreover, long-term mortality and morbidity following surgery with conventional prostheses remain high. Allografts may represent a suitable alternative in tricuspid surgery. This study aimed to compare outcomes between stented biological valves and mitral allografts (MAs) for tricuspid valve replacement (TVR). Methods: A total of 54 patients with IE underwent TVR using either a stented bioprosthesis (B) or MA between January 2016 and July 2024. Clinical and echocardiographic data were analyzed in accordance with the Tricuspid-Valve Academic Research Consortium (T-VARC) criteria. Early safety, clinical efficacy, and time-to-event survival were compared between the two equal B and MA groups. Results: There were no in-hospital or 30-day mortality, nor cardiac, cerebral, and wound complications in either group. The peak and mean pressure gradient (PG) on TV after surgery were 9.2 (6.5–12.0) and 4.0 (3.2–6.0) mmHg in the B group versus 6.0 (4.5–7.5) and 3.0 (2.0–4.0) mmHg in the MA group (p < 0.001). A T-VARC-adjusted analysis demonstrated superior freedom from cardiovascular mortality, recurrent IE, reoperation, and permanent pacemaker implantation (PPI) in the MA group 2 years after operation. Kaplan–Meier analysis revealed significantly higher freedom from cardiovascular mortality in the MA group (100% vs. 81.5%, 77.8%, 77.8%, 69.6% respectively (log-rank test, p = 0.011) at 12-, 18-, 24-, 36-months, and freedom from PPI (100% vs. 81% at all time intervals) (log-rank test, p = 0.021). Conclusion: Application of contemporary endpoint criteria demonstrated superior outcomes with MA, including lower cardiovascular mortality, reduced PPI, fewer recurrent endocarditis, decreased reoperations, cardiac hospitalizations, alongside improved patient-reported outcomes. Time-to-event analysis demonstrated benefits in cardiovascular survival and PPI avoidance with allografts. Mitral allograft may be a preferable alternative valve substitute for TVR in patients with IE. Clinical Trial Registration: ClinicalTrials.gov ID: NCT06591000, https://clinicaltrials.gov/study/NCT06591000?term=NCT06591000&rank=1, registration date: September 19, 2024.https://www.imrpress.com/journal/RCM/26/7/10.31083/RCM37204endocarditisallografttricuspid valve replacement |
| spellingShingle | Mikhail Nuzhdin Yury Malinovsky Maksim Galchenko Roman Komarov Aleksey Fokin Nikita Nadtochiy Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis Reviews in Cardiovascular Medicine endocarditis allograft tricuspid valve replacement |
| title | Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis |
| title_full | Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis |
| title_fullStr | Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis |
| title_full_unstemmed | Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis |
| title_short | Stented Biological Prosthesis Versus Mitral Allograft in Surgical Treatment of Tricuspid Valve Infective Endocarditis |
| title_sort | stented biological prosthesis versus mitral allograft in surgical treatment of tricuspid valve infective endocarditis |
| topic | endocarditis allograft tricuspid valve replacement |
| url | https://www.imrpress.com/journal/RCM/26/7/10.31083/RCM37204 |
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