A Systematic Review of Infective Endocarditis in Patients With Bovine Jugular Vein Valves Compared With Other Valve Types

Sharma, Ashutosh; Coté, Anita T.; Hosking, Martin; Harris, Kevin C.

doi:10.1016/j.jcin.2017.04.025

Cited by 77 publications

(52 citation statements)

References 55 publications

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“…In a recent meta‐analysis of 50 studies involving 7063 patients, bovine jugular vein valves, independent of implantation technique, were associated with a higher cumulative risk of IE compared with other types of right ventricle‐to‐pulmonary artery conduits (median cumulative incidence, 5.4% versus 1.2%; P <0.0001). There was no difference in the incidence of endocarditis between catheter‐based and surgically implanted bovine valves, suggesting that the substrate for infection is related to the tissue precursor of the valve 8. However, this meta‐analysis is limited by reporting the incidence of endocarditis, which is a time‐dependent event, in terms of a crude cumulative incidence 53…”

Section: Discussionmentioning

confidence: 98%

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Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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BackgroundInfective endocarditis (IE) after transcatheter pulmonary valve implantation (TPVI) in dysfunctioning right ventricular outflow tract conduits has evoked growing concerns. We aimed to investigate the incidence and the natural history of IE after TPVI with the Melody valve through a systematic review of published data.Methods and ResultsPubMed, EMBASE, and Web of Science databases were systematically searched for articles published until March 2017, reporting on IE after TPVI with the Melody valve. Nine studies (including 851 patients and 2060 patient‐years of follow‐up) were included in the analysis of the incidence of IE. The cumulative incidence of IE ranged from 3.2% to 25.0%, whereas the annualized incidence rate ranged from 1.3% to 9.1% per patient‐year. The median (interquartile range) time from TPVI to the onset of IE was 18.0 (9.0–30.4) months (range, 1.0–72.0 months). The most common findings were positive blood culture (93%), fever (89%), and new, significant, and/or progressive right ventricular outflow tract obstruction (79%); vegetations were detectable on echocardiography in only 34% of cases. Of 69 patients with IE after TPVI, 6 (8.7%) died and 35 (52%) underwent surgical and/or transcatheter reintervention. Death or reintervention was more common in patients with new/significant right ventricular outflow tract obstruction (69% versus 33%; P=0.042) and in patients with non‐streptococcal IE (73% versus 30%; P=0.001).ConclusionsThe incidence of IE after implantation of a Melody valve is significant, at least over the first 3 years after TPVI, and varies considerably between the studies. Although surgical/percutaneous reintervention is a common consequence, some patients can be managed medically, especially those with streptococcal infection and no right ventricular outflow tract obstruction.

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Section: Discussionmentioning

confidence: 98%

“…The incidence rate of Melody valve IE varies considerably among the studies and is, reportedly, higher than the rate of pulmonary homograft IE 5, 8. Beyond the incidence rate, many other basic aspects of this disease entity remain obscure, including microbiologic features, presentation, and outcomes.…”

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confidence: 99%

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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“…From the published experience with the BJV in other positions, several issues have been raised, including the increased risk of infective endocarditis, 17 graft dissection, 18 aneurysmal dilatation, 19 distal graft stenosis, 6 and graft thrombosis 5 . Previous studies show that the risk of thrombosis after TCPC varies widely, 20 and in a meta‐analysis 21 ; the reported thromboembolism rate was 11.7%.…”

Section: Discussionmentioning

confidence: 99%

Bovine jugular vein valved xenograft for extracardiac total cavo‐pulmonary connection: The risk of thrombosis and the potential liver protection effect

et al. 2020

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Background Currently, non‐valved conduits are preferred for extracardiac total cavo‐pulmonary connection (TCPC). However, previous work has failed to provide objective data comparing the postoperative outcome between non‐valved TCPCs and bovine jugular vein valved xenograft (BJV) TCPCs. Hence, the objective of this study is to compare the postoperative outcomes in extracardiac TCPC patients who received BJV vs synthetic non‐valved conduits and evaluate the effect of BJV on liver fibrosis. Methods Of 206 patients who had extracardiac TCPC from 2002 to 2017 were divided into three groups. Group A (n = 66) received BJV, group B (n = 37) received PET conduits and group C (n = 103) received polytetrafluoroethylene (PTFE) tube. Study endpoints were hospital outcomes, conduits thrombosis, reinterventions, and survival. Liver stiffness and fibrosis were assessed in eight patients with BJV. Results Preoperative parameters were comparable among groups. Thrombosis was significantly lower in group C (P < .0003) but no difference between groups A and B (P = .951). Reinterventions did not differ significantly among groups (Log‐rank P = .598). Hospital deaths occurred in seven patients (3.4%). There was no difference in survival between groups (Log‐rank P = .221). The median liver stiffness score was 18.65 kPa and the eight patients had advanced liver fibrosis (grade F3‐4) in group A. Conclusion PTFE is the recommended conduit for TCPC with a lower risk of thrombosis compared to BJV and PET. BJV conduits in TCPC circuits may not protect against liver fibrosis. BJV should not be considered as an option for TCPC.

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“…5,12 All complications were seen in the two most common types of Melody [18][19][20] In addition, there is an increased incidence in infective endocarditis in bovine jugular venous conduits compared to homograft conduits. [22][23][24] Bovine jugular venous valve morphology deserves further investigation to determine if there is an association with endocarditis. [22][23][24] Bovine jugular venous valve morphology deserves further investigation to determine if there is an association with endocarditis.…”

Section: Discussionmentioning

confidence: 99%

“…21 This suggests a correlation to the bovine tissue, but this increased incidence may be due to conduit stenosis and not due to the tissue itself. [22][23][24] Bovine jugular venous valve morphology deserves further investigation to determine if there is an association with endocarditis.…”

Section: Discussionmentioning

confidence: 99%

Leaflet morphology classification of the Melody Transcatheter Pulmonary Valve

Boe

Cheatham

Armstrong

et al. 2018

Congenital Heart Disease

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Objective:We sought to describe the leaflet morphology variation in the Melody Transcatheter Pulmonary Valve (TPV) and evaluate associated outcomes. The Melody TPV is constructed from harvested bovine jugular venous valves which have been rigorously tested. Natural anatomic leaflet variations are seen in the Melody TPV but have not been evaluated.Design: A Melody TPV leaflet morphology classification system was devised after reviewing a subset of photographed and implanted TPVs. All images were blindly reviewed by implanters and classified. Midterm hemodynamic outcomes and complications of the Melody TPVs were compared by leaflet morphology. Results: Photographed Melody TPVs implanted between 2011 and 2016 (n = 62)were categorized into the following leaflet morphology types: A-symmetric trileaflet (47%); B-asymmetric trileaflet with a single small leaflet (32%); C-asymmetric trileaflet with a single large leaflet (16%); D-rudimentary leaflet with near bicuspid appearance (5%). Acceptable hemodynamic function at 6 months postimplantation was seen in 97.5% of valves. Over a median follow-up of 1.5 years (range 0-4.4 years), two TPVs (Type A) had > mild regurgitation. Nine TPVs developed complications (endocarditis, 3; stent fracture, 2; refractory arrhythmia, 1; conduit replacement, 2; death, 1), of which 6 required reintervention. There was no significant difference in outcomes based on Melody TPV leaflet morphology type. Conclusions:The Melody TPV can be classified into one of four categories based on leaflet morphology. Study outcomes were not associated with leaflet morphology.Further documentation and evaluation of Melody TPV morphology may lead to better understanding of this technology. K E Y W O R D S congenital catheterization, transcatheter valve implantation 1 | INTRODUC TI ON The Melody Transcatheter Pulmonary Valve (TPV) (Medtronic, Dublin, Ireland) is designed to treat right ventricular outflow tract (RVOT) conduit dysfunction and was the first implanted transcatheter heart valve in 2000. 1 Since the United States Investigational Device Trial in 2007, the Melody TPV has been utilized in a variety of patients and anatomic locations. As of 2016, more than 10 000 | 303 BOE Et al. center study, which is in large part due to the excellent midterm function and low rate of complications of the Melody TPV. Our study provides a Melody TPV morphologic classification system on which to base further research. Prospective classification of morphology type and further study of Melody valve morphology may lead to better understanding of associated outcomes. -conception and design, analysis and interpretation of data, drafting of the manuscript, critically revising the manuscript, final approval of the submitted manuscript. Aimee K. Armstrong-conception and design, critically revising the manuscript, final approval of the submitted manuscript. Darren P. Berman-critically revising the manuscript, final approval of the submitted manuscript. Joanne L. Chisolm-analysis and interpretation of data, critically revising the ...

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A Systematic Review of Infective Endocarditis in Patients With Bovine Jugular Vein Valves Compared With Other Valve Types

Cited by 77 publications

References 55 publications

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Bovine jugular vein valved xenograft for extracardiac total cavo‐pulmonary connection: The risk of thrombosis and the potential liver protection effect

Leaflet morphology classification of the Melody Transcatheter Pulmonary Valve

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