Impact of percutaneous pulmonary valve implantation procedural steps on leaflets histology and mechanical behaviour: An in vitro study

Jalal, Zakaria; Galmiche, Louise; Beloin, Christophe; Boudjemline, Younès

doi:10.1016/j.acvd.2016.01.015

Cited by 21 publications

(16 citation statements)

References 27 publications

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“…A selective propensity of bovine jugular tissue (the precursor of the Melody valve leaflets) to histological lesions during procedural steps45 and to bacterial adherence46 was shown in in‐vitro studies, especially after procedural manipulation‐induced leaflet damage 46. These findings are in line with the observed higher propensity of valves with bovine jugular vein leaflets (Melody valve and Contegra graft) to IE than pulmonary homografts 18, 19, 47.…”

Section: Discussionsupporting

confidence: 62%

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: Discussionsupporting

confidence: 62%

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

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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“…ex vivo studies present a mixed picture with one study demonstrating a higher likelihood of bacterial adhesion to bovine jugular venous valve leaflet tissue when compared to bovine pericardial leaflet tissue whereas another study demonstrated no significant difference . The transcatheter implantation technique, involving crimping and balloon expansion, has been hypothesized to potentially alter topography of the valve, providing a favorable site for bacterial adhesion …”

Section: Discussionmentioning

confidence: 99%

“…18,19 The transcatheter implantation technique, involving crimping and balloon expansion, has been hypothesized to potentially alter topography of the valve, providing a favorable site for bacterial adhesion. 20,21 The clinical presentation of IE following TCPVR is variable. The Suppressive long-term oral antibiotics are of unclear benefit, there is a lack of compelling data to support or refute this strategy.…”

Section: Discussionmentioning

confidence: 99%

Risk factors for infective endocarditis following transcatheter pulmonary valve replacement in patients with congenital heart disease

Sadeghi¹,

Wadia²,

Lluri³

et al. 2019

Cathet Cardio Intervent

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Objectives We sought to delineate the risk factors for infective endocarditis (IE) in patients undergoing transcatheter pulmonary valve replacement (TCPVR). Background Despite the therapeutic benefits of TCPVR for treatment of dysfunctional right ventricular outflow tracts, IE is a major complication of the approach. Specific hemodynamic gradients and patient immune status as predisposing factors for IE are largely unexplored. Methods We performed a retrospective review of patients who had undergone TCPVR at UCLA between October 2010 and October 2017. Cases of IE were diagnosed based on the modified Duke criteria. Results Two hundred and thirty‐five cases of TCPVR were performed with a mean follow‐up of 2.6 years (range 0.0–8.0 years). Sixteen distinct IE events developed in 13 patients (Melody™ n = 12, SAPIEN n = 1), with a median time from implant to IE of 3.3 years (range 2.0–7.2 years). Univariate Cox regression showed that immunocompromised status was significantly associated with the development of IE hazard ratios (HR 5.43 [1.80–16.4], p = .003). Kaplan–Meier curves show that the 5‐year freedom from IE among immunocompetent patients was 87% (95% CI 78–96%) versus 64% (95% CI 39–89%) among immunocompromised patients (log‐rank p = .02). Postimplant right ventricular systolic pressure was higher among immunocompromised patients (p = .03). The risk of IE post‐TCPVR in immunocompromised patients with residual pulmonary stenosis was 43%. Conclusions Among the risk factors examined in this study, immunocompromised status was the most significant predictor of IE development post‐TCPVR. Patients with the lowest risk of IE are those with competent immune systems, without a history of IE, and with minimal residual pulmonary valve gradients post‐TCPVR.

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“…Several factors explaining this remarkable difference have been discussed. One of the main differences between transcatheter and surgical valve replacement is possible valvular damage before percutaneous implantation during crimping and during balloon expansion, whereas surgical prostheses are placed directly in the RVOT without any manipulation [43]. There is a higher incidence of reported endocarditis in patients after Melody valve implantation compared with SAPIEN.…”

Section: Late Complicationsmentioning

confidence: 99%

“…Long-term anticoagulation or antiplatelet therapy was suggested to reduce the incidence of initial thrombus formation in an area of endothelial damage which could be the location of infective vegetations after transient bacteremia [43]. …”

Section: Late Complicationsmentioning

confidence: 99%

Percutaneous pulmonary valve implantation – state of the art and Polish experience

Biernacka¹,

Rużyłło²,

Demkow³

2017

pwki

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Percutaneous pulmonary valve implantation (PPVI) is a relatively new method of treating patients with right ventricular outflow tract (RVOT) dysfunction after surgical repair of congenital heart disease. Since its introduction in 2000 by Bonhoeffer, more than ten thousand PPVI procedures have been performed worldwide. Indications for PPVI have been adapted from those accepted for surgical intervention. Two types of valves are being used: Melody Medtronic available in diameters 16 mm and 18 mm and the family of Edwards SAPIEN valves 23, 26 and 29. The procedure has been shown to be feasible and safe when performed in patients with full pulmonary conduit dysfunction and in selected cases of patched RVOT. The low complication rate and the reduced number of open-chest re-interventions over a patient’s lifetime are among the main advantages of the procedure. The most important problem responsible for late mortality and reinterventions is infective endocarditis. Size restrictions of the currently available valves limit deployment in the majority of patients with a wide RVOT. Newer devices are being developed to make these patients suitable for PPVI. A literature review, Polish experience and results of PPVI performed in 66 patients in the Institute of Cardiology in Warsaw are briefly reported.

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Impact of percutaneous pulmonary valve implantation procedural steps on leaflets histology and mechanical behaviour: An in vitro study

Cited by 21 publications

References 27 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

Risk factors for infective endocarditis following transcatheter pulmonary valve replacement in patients with congenital heart disease

Percutaneous pulmonary valve implantation – state of the art and Polish experience

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