Infective endocarditis in right ventricular outflow tract conduits: a register-based comparison of homografts, Contegra grafts and Melody transcatheter valves

Abstract

OBJECTIVES The aim was to investigate the incidence of infective endocarditis (IE) in right ventricle-to-pulmonary artery conduits implanted at a Danish tertiary centre. METHODS Cases of IE in patients with homografts, Contegra grafts and Melody transcatheter valves were evaluated retrospectively with regard to the likeliness of the diagnosis using the modified Duke criteria and the likeliness of conduit involvement. Incidence rates for IE were calculated 1 and 5 years after valve implantation for all 3 conduits, and separately for Melody subgroups depending on which conduit served as landing zone. Cox regression with time-dependent covariates was used to model the impact of the conduit type on the incidence of IE. RESULTS Annualized incidence rates of IE in homografts, Contegra grafts and Melody valves were 0.40% (0.40 cases per 100 patient-years), 0.97% and 6.96% 1 year and 0.27%, 1.12% and 2.89% 5 years after valve implantation. Hazard ratios (HRs) were 3.20 [95% confidence interval (CI) 0.91–11.17, P = 0.069] for Contegra grafts and 11.89 (95% CI 2.91–48.48, P < 0.001) for Melody valves compared to homografts. CONCLUSIONS Bovine pulmonary conduits were more prone to endocarditis, with Melody valves being the most frequently infected. HRs for the risk of suffering from endocarditis were substantially higher for Melody valves and Contegra grafts compared to homografts, although this finding was only statistically significant for Melody valves and not for Contegra grafts.

The risk of infective endocarditis following interventional pulmonary valve implantation: A meta-analysis

“…Some studies have already shown that the bovine Contegra 1 graft has an increased IE risk compared to other surgical implants [55,56]. Van Dijck et al [42] found in a large national cohort study an increased risk of IE for the same biological substrate (Contegra 1 Conduit and Melody 1 valve) when related to homografts.…”

Application of Homograft Valved Conduit in Cardiac Surgery

“…The probability of avoiding reoperation was significantly better in patients with implanted BJV conduits than in the pulmonary artery group (85 and 47%, respectively; P < 0.001). Although the early performance of BJVs may be superior to that of homografts, the incidence of infective endocarditis after right ventricle-pulmonary artery conduit implantation suggests that conduits of bovine origin are more susceptible to endocarditis ( 52 , 53 ), which may be associated with suboptimal hemodynamics ( 54 ) and thrombus apposition at the basis of conduit valve sinus ( 55 ). Meanwhile, Mercer et al ( 56 ) demonstrated that polytetrafluoroethylene conduits with mitral valves are ideal for right ventricular outflow tract reconstruction in children under 2 years of age.…”

Seven decades of valved right ventricular outflow tract reconstruction: The most common heart procedure in children

“…9,[27][28][29][30] A recent registry report from Denmark found an annualized incidence of infective endocarditis at 5 years of 0.27% for homografts, 1.12% for BJVC, and 2.89% for Melody valves. 31 The BJVC and Melody valves, which have the same tissue composition, typically have greater reported rates of endocarditis than other conduit types. In the Melody trials, the rate of endocarditis was as high as 21% at 5 years for Melody valve in children 12 years or younger, a rate much greater than for BJVC in other reports.…”