Tricuspid Valve Infective Endocarditis in People Who Inject Drugs: A Single-Center Retrospective Observational Study of Percutaneous Mechanical Aspiration and a Surgical Approach

Background: People who inject drugs (PWID) comprise the majority of patients with native tricuspid valve (TV) infective endocarditis (IE). Many patients require surgical repair or replacement of their TV, but some may be deemed ineligible for surgical management due to high operative risk or patient preference. Vacuum-assisted percutaneous mechanical aspiration (PMA) has emerged as a potential alternative to surgical management in this population. The objective of this study was to describe real-world patient characteristics and clinical outcomes in PWID who underwent PMA or surgical management of TV IE. Methods: We retrospectively reviewed PWID hospitalized with endocarditis at a single tertiary care center (2016–2025) who underwent an isolated PMA or surgical TV repair/replacement (TVR). Baseline demographic, clinical, microbiologic, and echocardiographic characteristics were described. Clinical outcomes were compared descriptively between groups, recognizing imbalances in treatment selection. Results: A total of 40 PWID met inclusion criteria; 17 underwent PMA and 23 underwent surgical TVR. There was substantial baseline clinical heterogeneity between the two groups. Procedural success was numerically higher with surgery than with PMA (95.7% vs. 88.2%). Clinical success, a composite of procedural success, treatment completion, and lack of need for reintervention, was numerically higher in the TVR group (73.9% vs. 52.9%). One-year mortality was similar between groups. Conclusions: In this single-center retrospective observational cohort of PWID with isolated TV IE, there was no statistical difference in composite clinical or procedural success between patients who underwent PMA or TVR. PMA may be a feasible source-control strategy for select patients not eligible for immediate surgery; however, larger prospective studies are needed to define optimal patient selection factors and comparative effectiveness.