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

Abstract

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.

Endocarditis in Bovine Vein Grafts in the Pulmonary Position Placed Surgically & Percutaneously

“…9,24,25 In terms of risk factors for IE, previous studies have suggested that cessation of anticoagulant post PVR, immunocompromised status and chromosomal or genetic abnormality are risk factors for development of endocarditis. 26,27 Poynter et al indicated that conduit z-score is an important predictor of conduit durability, however, our results demonstrated no significant difference in z-score between IE-positive and IE-negative groups. 28 We examined the residual/discharge peak gradient post PVR as a risk factor for IE development, and observed no statistical significance.…”

COVID-19 infection with delayed presentation of infective endocarditis of the prosthetic pulmonary valve

“…There has been hypothesis of transcatheter implantation technique involving crimping and balloon expansion that cause alternation of anatomy of the valve causing favourable site for bacterial colonisation. 4 Melody TM valve (Medtronic, Inc., Minneapolis, MN), Edwards Sapien valve (Edwards life sciences, Irvine, CA), and Venus P valve (Venus Medtech, Hangzhou, China) are commonly available valves being used for transcatheter pulmonary valve implantation. The incidence of infective endocarditis was reported higher in Melody TM valve due to increased propensity of valves with bovine jugular tissue for bacterial adherence.…”

Transcatheter Interventions in Patients With Adult Congenital Heart Disease

“…Infective endocarditis is a serious concern and may have occurred in up to 10% of patients with dysfunctional homografts being considered for intervention; a history of endocarditis, immunocompromised state, and residual stenosis after TPVR are risk factors for endocarditis following TPVR. [91][92][93][94] Stent fracture has been noted to be a problem with the Melody valve, especially when prestenting is not performed within conduits or native right ventricular outflow tracts (RVOTs). Prestenting does not appear to be necessary for bioprosthetic valves for valve-in-valve procedures, given the presence of a metallic or plastic ring, which protects the stent platform from compressive forces.…”