Department of Clinical Pharmacy and Translational Science, College of Pharmacy, University of Tennessee Health Science Center, Knoxville, Tennessee; Department of Pharmacy, University of Tennessee Medical Center, Knoxville, Tennessee.
Department of Cardiology, Tennova Heart North Knoxville Medical Center, Powell, Tennessee.
Ann Thorac Surg. 2021 May;111(5):1451-1457. doi: 10.1016/j.athoracsur.2020.08.036. Epub 2020 Oct 20.
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.
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.
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.
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.
在注射毒品人群（PWID）中，三尖瓣感染性心内膜炎（TVIE）的瓣膜手术存在争议，因为复发会导致再次感染的风险。本研究旨在比较经皮机械抽吸（PMA）与瓣膜手术治疗 PWID 合并 TVIE 的结果。
回顾性纳入 2014 年 1 月至 2019 年 4 月期间因确诊 TVIE 住院且接受 PMA 或瓣膜手术治疗的成年 PWID 患者。主要终点为全因 12 个月死亡率；次要终点包括院内死亡率和全因 12 个月再入院率。
共纳入 85 例患者：42 例行 PMA，43 例行瓣膜手术。两组患者的基线人口统计学特征相似；62 例（73%）患者为女性，中位年龄为 31 岁（四分位距，27-41）。74 例（86%）患者有既往感染性心内膜炎病史，在手术干预前接受了长期抗生素治疗；33 例（38%）患者入院时即出现感染性休克。最常见的病原体为耐甲氧西林金黄色葡萄球菌（n=84 例中的 32 例，38%）。5 例（12%）PMA 患者在院内死亡，而 1 例（2%）行瓣膜手术的患者死亡（P=0.11）。PMA 组和手术组的全因 12 个月死亡率分别为 24%和 19%（P=0.57）。考虑混杂因素后，PMA 组和瓣膜手术组的全因 12 个月死亡率无差异（校正比值比，1.5；95%置信区间，0.48-4.8）；次要结局也无显著差异。
对于 PWID 合并 TVIE，PMA 的治疗结果与瓣膜手术相似。PMA 可能替代瓣膜手术作为治疗或桥接策略，以在 PWID 接受成瘾治疗的同时进行手术。
