Abstract 12386: A Conservative Treatment Strategy for Fulminant Right Sided Infective Endocarditis: Long Term Outcomes

Introduction: Right sided infective endocarditis (IE) related to intravenous drug use (IVDU) can result in valve destruction, severe tricuspid regurgitation (TR) and septic pulmonary embolism (SPE). In patients at high risk of IE recurrence from resumption of IVDU, management poses ethical dilemmas. We examined the impact of conservative management on long term outcomes. Methods: We studied patients with IVDU related right sided IE and severe TR at presentation. Surgery was considered indicated if there was a) anticipated poor response to antibiotics (persistent septicemia, vegetation size >20 mm, multi-resistant organism, recurrent SPE) b) abscess formation c) left sided IE and d) refractory right heart failure (HF). Patients were stratified based on surgical indication and eventual management. Results: From 2005 through 2016, there were 33 patients (24 males, mean age 35±8 years) with severe TR due to IVDU related IE. Median follow up was 6.4 years. Past history included IE (n=7), HF (n=1) and left side...