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Background: This study evaluates the impact of secondary functional tricuspid regurgitation (TR) and concomitant tricuspid valve repair (TVr) at the time of left‐sided valve operations. Methods: Adults undergoing left‐sided valve operations between 2010 and 2019 at a multihospital academic institution were included. Patients were stratified into three groups: less‐than‐moderate TR without TVr (Group 1), moderate‐or‐greater TR without TVr (Group 2), and moderate‐or‐greater TR with TVr (Group 3). Primary outcomes included survival and hospital readmissions. Secondary outcomes included major postoperative morbidities. Multivariable logistic regression evaluated risk‐adjusted mortality and readmission. Results: About 3444 patients were included in the analysis and were stratified into Group 1 (n = 2612, 75.8%), Group 2 (n = 563, 16.3%), and Group 3 (n = 269, 7.8%). Patients with moderate or greater TR (Groups 2 and 3) had higher rates of mortality, hospital readmissions and major postoperative complications including reoperations, renal failure requiring dialysis, blood transfusions, and prolonged ventilation (all, p <.05). When assessed individually, the Group 3 had substantially higher rates of renal failure requiring dialysis, prolonged ventilation, and reoperations, although the Group 2 had higher rates of 30‐day mortality (all, p <.05). These findings persisted in risk‐adjusted analysis with the highest hazards for mortality (hazard ratio [HR] 1.9, 95% confidence interval [CI] 1.7–2.2) and readmission (HR 1.3, 95% CI 1.2–1.5) appreciated in the Group 2. Conclusions: In this analysis of 3444 patients, those with moderate‐to‐severe TR who did not undergo a TVr at the time of their left‐sided valve operation had substantially higher risks of mortality and hospital readmissions compared with those who did undergo TV surgery. [ABSTRACT FROM AUTHOR]

Introduction: This study evaluated surgical outcomes of infective endocarditis (IE), with particular attention to the impact of intravenous drug use (IVDU). Methods: Adult patients undergoing surgery for IE between 2011 and 2018 at a single center were included and stratified by IVDU. The primary outcome was overall survival. Secondary outcomes included postoperative complications and hospital readmissions. Kaplan‐Meier and multivariable Cox regression were utilized for unadjusted and risk‐adjusted survival analyses, respectively. Cumulative incidence function curves were compared for hospital readmissions. Results: A total of 831 patients (mean age 55 years, 34.4% female) were operated on for IE, including 318 (38.3%) with IVDU. Cultures were most commonly positive for streptococcus (25.2%), methicillin‐sensitive Staphylococcus aureus (17.7%), enterococcus (14.3%), or methicillin‐resistant Staphylococcus aureus (8.4%). The most common procedures included isolated aortic valve repair/replacement (18.8%), aortic root replacement (15.9%), mitral valve repair/replacement (26.7%), aortic and mitral valve replacement (8.4%), and tricuspid valve repair/replacement (7.6%). Mean follow‐up was 3.4 ± 2.4 years. Overall 5‐year survival was 64% and was similar between IVDU and non‐IVDU. Multivariable analysis demonstrated that IVDU was not associated with mortality risk. IVDU patients displayed higher rates of all‐cause readmission (61.6% vs 53.9%; P =.03), drug‐use readmission (15.4% vs 1.4%; P <.001), and recurrent endocarditis readmission (33.0% vs 13.0%; P <.001). Conclusions: The majority of patients undergoing surgical treatment of IE are alive at 5‐years although readmission rates are high. IVDU is not a risk factor for longitudinal mortality although patients with IVDU are at higher overall readmission risk, driven largely by greater readmissions for drug‐use and recurrent endocarditis. [ABSTRACT FROM AUTHOR]