Comparison of Outcomes of Percutaneous Mechanical Aspiration vs Tricuspid Valve Surgery in Drug Use-Associated Endocarditis of the Tricuspid Valve.

BACKGROUND

People who inject drugs (PWID) and present with infective endocarditis (IE) of the tricuspid valve may need valve surgery due to persistent infection, heart failure, or embolic risk. Vacuum-assisted percutaneous mechanical aspiration (PMA) has been proposed as a potential option for those who cannot undergo surgery.

METHODS

We queried TriNetX, a database that provides access to electronic medical record data across health care organizations, to identify PWID who had tricuspid valve IE and underwent PMA between 2016 and 2024, using diagnostic and procedure codes. Short-term procedural and clinical outcomes were compared with PWID who underwent tricuspid valve surgery.

RESULTS

In total, 129 patients underwent the PMA procedure and 952 had valve surgery. A higher proportion of the PMA cohort was female (66% vs 57%) and of non-White race (32% vs 22.5%). At 1 month postprocedure, the surgical group had a lower rate of death (2.5% vs 7.9%, = .001), while the PMA group had a lower risk of heart block or need for pacemaker implantation (0% vs 4%). After propensity matching between groups, these differences were not significant. At 1 year postprocedure, groups had similar rates of heart failure, tricuspid insufficiency, or offer of treatment intervention for opioid use disorder.

CONCLUSIONS

Short-term outcomes seem comparable between PMA and tricuspid valve surgery in tricuspid valve IE in PWID. Additional studies with larger cohort numbers are needed to further evaluate the difference in long-term postoperative outcomes between the groups.