Bloodstream Infections Occurring in Patients With Percutaneously Implanted Bioprosthetic Pulmonary Valve

Buber, Jonathan; Bergersen, Lisa; Lock, James E.; Gauvreau, Kimberlee; Esch, Jesse J.; Landzberg, Michael J.; Valente, Anne Marie; Sandora, Thomas J.; Marshall, Audrey C.

doi:10.1161/circinterventions.112.000348

Cited by 91 publications

(69 citation statements)

References 27 publications

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“…Consistent with recent reports focused on the issue of endocarditis after TPVR, 21,[27][28][29] infection was a notable adverse outcome in this series. At the time the database was locked for this analysis, only basic data were available for most of the reported cases of endocarditis because details were not included among routine follow-up data collection elements, so only preliminary analysis was performed.…”

Section: Other Adverse Melody Valve-related Outcomessupporting

confidence: 91%

Clinical and Hemodynamic Outcomes up to 7 Years After Transcatheter Pulmonary Valve Replacement in the US Melody Valve Investigational Device Exemption Trial

et al. 2015

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Background-Studies of transcatheter pulmonary valve (TPV) replacement with the Melody valve have demonstrated goodshort-term outcomes, but there are no published long-term follow-up data. Methods and Results-The US Investigational Device Exemption trial prospectively enrolled 171 pediatric and adult patients (median age, 19 years) with right ventricular outflow tract conduit obstruction or regurgitation. The 148 patients who received and were discharged with a TPV were followed up annually according to a standardized protocol. During a median follow-up of 4.5 years (range, 0.4-7 years), 32 patients underwent right ventricular outflow tract reintervention for obstruction (n=27, with stent fracture in 22), endocarditis (n=3, 2 with stenosis and 1 with pulmonary regurgitation), or right ventricular dysfunction (n=2). Eleven patients had the TPV explanted as an initial or second reintervention. Five-year freedom from reintervention and explantation was 76±4% and 92±3%, respectively. A conduit prestent and lower discharge right ventricular outflow tract gradient were associated with longer freedom from reintervention. In the 113 patients who were alive and reintervention free, the follow-up gradient (median, 4.5 years after implantation) was unchanged from early post-TPV replacement, and all but 1 patient had mild or less pulmonary regurgitation. Almost all patients were in New York Heart Association class I or II. More severely impaired baseline spirometry was associated with a lower likelihood of improvement in exercise function after TPV replacement. Conclusions-TPV replacement with the Melody valve provided good hemodynamic and clinical outcomes up to 7 years after implantation. Primary valve failure was rare. The main cause of TPV dysfunction was stenosis related to stent fracture, which was uncommon once prestenting became more widely adopted. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00740870. (Circulation.

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Section: Other Adverse Melody Valve-related Outcomessupporting

confidence: 91%

Clinical and Hemodynamic Outcomes up to 7 Years After Transcatheter Pulmonary Valve Replacement in the US Melody Valve Investigational Device Exemption Trial

et al. 2015

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“…AS indicates aortic stenosis; IE, infective endocarditis; HACEK, Haemophilus parainfluenzae, H. aphrophilus, H. paraphrophilus, H. influenzae, Actinobacillus actinomycetemcomitans, Cardiobacterium hominis, Eikenella corrodens, Kingella kingae, and K. denitrificans; PG, pressure gradient; PR, pulmonary regurgitation; RVOT, right ventricular outflow tract; S/P, status post; TA, truncus arteriosus; TGA, transposition of the great arteries; TOF, tetralogy of Fallot; TPVI, transcatheter pulmonary valve implantation.aFrom 22 reports published between 2011 and 2017 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38b

Corynebacterium pseudodiphtheriticum in 3 cases and Corynebacterium striatum in 1 case.

Haemophilus influenzae in 1 case and Haemophilus parainfluenzae in another case.

In 3 cases, serologic findings and polymerase chain reaction of excised valves revealed Bartonella henselae .

…”

Section: Resultsmentioning

confidence: 99%

“…From 22 reports published between 2011 and 2017 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38…”

Section: Resultsmentioning

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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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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“…15 After Melody TPVR, the overall incidence and annualized rate of IE reported in this study is comparable to studies of IE after Melody TPVR in general. 24,25 Additionally, a diagnosis of IE before TPVR was not associated with an increased risk of IE after Melody TPVR; in fact, none of the patients who developed IE after Melody valve implant were among those with a known history of IE pre-TPVR, which suggests that Melody-in-Contegra implants do not confer a heightened risk of this complication. Although the incidence of IE was low, the clinical implications of valve-associated IE were significant, as all patients with IE involving the valve underwent TPV explant.…”

Section: Discussionmentioning

confidence: 95%

Multicenter Experience Evaluating Transcatheter Pulmonary Valve Replacement in Bovine Jugular Vein (Contegra) Right Ventricle to Pulmonary Artery Conduits

Morray

McElhinney

Boudjemline

et al. 2017

Circ: Cardiovascular Interventions

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The majority of Melody valves implanted early in the experience were within cryopreserved homograft conduits. A relatively common alternative to homograft conduits for RVOT reconstruction is the Contegra pulmonary valve conduit, a glutaraldehyde-preserved bovine jugular vein conduit (Medtronic, Inc), which is available in a range of sizes (12-22 mm) for use Background-Follow-up of transcatheter pulmonary valve replacement (TPVR) with the Melody valve has demonstrated good short-term and long-term outcomes, but there are no published studies focused on valve performance in the Contegra bovine jugular vein conduit. Methods and Results-This is a retrospective, multicenter study of the short-and intermediate-term outcomes of Melody TPVR within the Contegra conduit in the right ventricle to pulmonary artery position. Data from 13 centers were included in the analysis. During the study period, 136 patients underwent 139 catheterizations for attempted Melody TPVR with a median follow-up of 3 years (1 day to 9.1 years). Of the 136 patients, 117 underwent successful Melody TPVR. Two patients underwent a second Melody TPVR. The majority of patients underwent placement of ≥1 stents before transcatheter pulmonary valve implantation. There was a significant reduction in peak conduit pressure gradient acutely after transcatheter pulmonary valve implantation (39 versus 10 mm Hg; P<0.001). At most recent follow-up, the maximum pulmonary valve gradient by echocardiogram remained significantly reduced relative to prevalve implant measurements (65.9 versus 27.3 mm Hg; P<0.001). The incidence of Melody transcatheter pulmonary valve stent fracture (3.4%) and infectious endocarditis (4.3%) were both low. Serious adverse events occurred in 3 patients. Conclusions-Melody TPVR in Contegra conduits is safe and effective and can be performed in a wide range of conduit sizes with preserved valve function and low incidence of stent fracture and endocarditis. (Circ Cardiovasc Interv.

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Bloodstream Infections Occurring in Patients With Percutaneously Implanted Bioprosthetic Pulmonary Valve

Cited by 91 publications

References 27 publications

Clinical and Hemodynamic Outcomes up to 7 Years After Transcatheter Pulmonary Valve Replacement in the US Melody Valve Investigational Device Exemption Trial

Clinical and Hemodynamic Outcomes up to 7 Years After Transcatheter Pulmonary Valve Replacement in the US Melody Valve Investigational Device Exemption Trial

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

Multicenter Experience Evaluating Transcatheter Pulmonary Valve Replacement in Bovine Jugular Vein (Contegra) Right Ventricle to Pulmonary Artery Conduits

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