Infective endocarditis after transcatheter approach versus surgical pulmonary valve replacement: A meta-analysis

Abstract

Background: In this meta-analysis, we aimed to assess the risk of infective endocarditis in transcatheter versus surgical pulmonary valve replacement patients. Methods: We systematically searched PubMed, Cochrane, EMBASE, Scopus, and Web of Science for the studies that reported the event rate of infective endocarditis in both transcatheter and surgical pulmonary valve replacement between December 2012 and December 2021. Random-effects model was used in the meta-analysis. Results: Fifteen comparison groups with 4,706 patients were included. The mean follow-up was 38.5±3.7 months. Patients with transcatheter pulmonary valve replacement had a higher risk of infective endocarditis than patients receiving surgically replaced valves (OR 2.68, 95% CI: 1.83-3.93, p<0.00001). The calculated absolute risk difference was 0.03 (95% CI: 0.01-0.05), indicating that if 1,000 patients received a surgical valve replacement, 30 cases of infective endocarditis would be prevented. A meta-regression of follow-up time on the incidence of infective endocarditis was not statistically significant (p=0.753). Conclusion: Although transcatheter pulmonary valve replacement is a feasible alternative to surgical replacement in severe right ventricular outflow tract dysfunction, the higher incidence of infective endocarditis in transcatheter replacement remains a significant concern. Regarding this analysis, surgical treatment of right ventricular outflow tract dysfunction is still a viable option in patients with prohibitive risk.

Infective Endocarditis among Pediatric Patients with Prosthetic Valves and Cardiac Devices: A Review and Update of Recent Emerging Diagnostic and Management Strategies

“…Reconstruction of the right ventricle ejection tract is a standard procedure, especially in adult congenital heart disease, but it is also becoming more common in children (Figure 7). Depending on the severity of the condition, patients may require multiple surgeries in the future [63]. To avoid or reduce multiple reinterventions, Phillip Bonhoeffer initially described the Medtronic Melody valve implantation procedure on humans in 2000 [64].…”

“…Studies also indicated that the risk of IE is more directly related to the valve tissue (e.g., bovine jugular veins versus others) than the valve implantation method. Contegra conduits and Melody valves derived from the same biological substrate demonstrate a significantly higher risk of IE than other biological pulmonary valve substrates (e.g., homografts, Sapien valves, and Hancock valves) [63,68]. Usually, prolonged antibiotic treatment for at least 6 weeks is enough to treat IE, but, in some cases, extraction of the prosthesis and pulmonary surgical replacement may be necessary.…”

Risk of Infective Endocarditis Post-transcatheter Pulmonary Valve Replacement Versus Surgical Pulmonary Valve Replacement: A Systematic Review

“…The incidence of IE was significantly lower in patients who received SPVR than those who received TPVR [ 28 ]. 1.4% of patients who underwent SPVR developed IE, compared to 3.4% of patients who underwent TPVR [ 29 ].…”

“…1.4% of patients who underwent SPVR developed IE, compared to 3.4% of patients who underwent TPVR [ 29 ]. Malekzadeh-Milani et al concluded that IE was significantly higher in patients with TPVR than SPVR [ 28 , 30 ]. O’Donnell et al noticed a drastic difference, with only 2% of SPVR patients developing IE compared to 16% who underwent TPVR [ 31 ].…”

“…IE occurred much sooner in the TPVR group than in the surgical group [ 30 ]. However, Cedkirdecki et al found that follow-up time post-TPVR and SPVR surgeries did not significantly differ in the risk of IE [ 28 ].…”