Purcell Madeleine, Gnilopyat Sergey, Makwana Bhargav, Narayanan Shivakumar
Department of Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA.
Department of Medicine, Lahey Hospital and Medical Center, Burlington, Massachusetts, USA.
Open Forum Infect Dis. 2025 Apr 25;12(5):ofaf259. doi: 10.1093/ofid/ofaf259. eCollection 2025 May.
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.
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.
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.
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.
注射毒品者（PWID）若出现三尖瓣感染性心内膜炎（IE），由于持续感染、心力衰竭或栓塞风险，可能需要进行瓣膜手术。对于无法接受手术的患者，真空辅助经皮机械抽吸术（PMA）已被提议作为一种潜在选择。
我们查询了TriNetX数据库，该数据库可提供跨医疗机构的电子病历数据访问权限，通过诊断和程序代码识别2016年至2024年间患有三尖瓣IE并接受PMA的PWID。将短期手术和临床结果与接受三尖瓣手术的PWID进行比较。
共有129例患者接受了PMA手术，952例接受了瓣膜手术。PMA队列中女性比例（66%对57%）和非白人种族比例（32%对22.5%）更高。术后1个月，手术组的死亡率较低（2.5%对7.9%，P = 0.001），而PMA组发生心脏传导阻滞或需要植入起搏器的风险较低（0%对4%）。两组进行倾向匹配后，这些差异不显著。术后1年，两组在心力衰竭、三尖瓣关闭不全或针对阿片类药物使用障碍提供治疗干预方面的发生率相似。
在PWID的三尖瓣IE中，PMA和三尖瓣手术的短期结果似乎具有可比性。需要更多队列数量的进一步研究来评估两组术后长期结果的差异。
