Outcomes of Percutaneous Mechanical Aspiration vs Tricuspid Valve Surgery in Drug Use–Associated Endocarditis

Overview

This study compared short-term and 1-year outcomes of percutaneous mechanical aspiration (PMA) versus tricuspid valve surgery in people who inject drugs (PWID) with tricuspid valve infective endocarditis (IE). Initial findings showed higher 1-month mortality in the PMA group but lower rates of heart block or pacemaker need; after propensity matching, differences were not statistically significant. At 1 year, both groups had similar rates of heart failure, tricuspid insufficiency, and opioid use disorder treatment offers.

Background

Infective endocarditis involving the tricuspid valve is increasingly common among PWID, who face unique challenges including higher recurrence rates and social determinants affecting care adherence. While surgery is often indicated for persistent infection or complications, PWID are frequently considered poor surgical candidates due to concerns about outcomes and adherence. Percutaneous mechanical aspiration (PMA) has emerged as a less invasive alternative to surgery, aiming to reduce vegetation burden and improve antibiotic efficacy. However, data comparing PMA and surgical outcomes in this population remain limited.

Data Highlights

Key Findings

• PMA patients had higher proportions of females and non-White individuals compared to surgical patients.
• At 1 month, surgical patients had significantly lower mortality (2.5% vs 7.9%, P = .001).
• PMA patients had no heart block or pacemaker implantation, whereas 4% of surgical patients did.
• After propensity score matching, differences in mortality and complications between groups were not statistically significant.
• At 1 year, rates of heart failure, tricuspid insufficiency, and opioid use disorder treatment offers were similar between PMA and surgical groups.

Clinical Implications

PMA may be a viable alternative to surgery for tricuspid valve IE in PWID, especially for those at high surgical risk or with barriers to operative management. Comparable long-term outcomes suggest PMA could reduce perioperative complications such as heart block. Individualized multidisciplinary care remains essential to optimize treatment decisions and address social determinants impacting this population.

Conclusion

Short-term and 1-year outcomes between PMA and tricuspid valve surgery in PWID with tricuspid valve IE appear comparable after adjustment for confounders. Larger studies are needed to further define long-term efficacy and optimal patient selection criteria.

References

1. Author/Source/2024 -- Outcomes of Percutaneous Mechanical Aspiration Compared to Tricuspid Valve Surgery in Endocarditis Associated with Drug Use