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

Abstract

Background: Interventional percutaneous pulmonary valve implantation (PPVI) was first reported in 2000. Today, two different valves are certified for this procedure [i.e. Medtronic Melody 1 valve (Medtronic, Dublin, Ireland) and Edwards Sapien TM valve (Edwards Lifesciences, Irvine, CA, USA)]. For a decade, studies have reported an increasing risk of infective endocarditis (IE) after PPVI; as patients for PPVI are usually younger, even a low annual incidence of IE is important. However, the overall incidence and potential differences between the valves remain unclear. Methods: A systematic literature search was performed in the databases Medline, Cochrane Library, and Embase including the clinical trials register. The aim was to summarize and compare the cumulative incidence of IE after PPVI. Using a sensitivity analysis we set the incidence rates of the two valve types in ratio with a normal population. Results: A total of 967 publications were identified searching for "pulmonary valve implantation," "PPVI," and 47 publications were used for final analysis. A total 3616 patients with Melody 1 valves and 501 with Sapien TM valves were included. IE after PPVI occurred in 214 patients with Melody 1 valves and in 5 patients only with Sapien TM valves. The pooled incidence for Melody 1 and Sapien TM valves was 4.9% (95% CI: 3.6-6.2) and 1.3% (95% CI: 0.3-2.3), respectively. Chi-square test was significant. The sensitivity analysis showed that the incidence rate ratio was 252.1 (95% CI: 187.6-338.6) for Melody 1 valves and for Sapien TM valves 2.7 (95% CI: 0.8-9.2). Conclusions: At present, there is an important difference for the risk of IE after PPVI. To reduce the risk of post PPVI endocarditis, a careful valve selection in favor of the Sapien TM valves seems to be beneficial.

Recurrent infective endocarditis in a patient after a second Melody valve placement

“…2 The risk of infective endocarditis after percutaneous pulmonary valve implantation with the Sapien valve seems to be lower than with the Melody valve. 4 However, the risk of recurrence of infective endocarditis in Melody valve placed inside a Melody valve is not clear and decision to place a second Melody valve after infective endocarditis of Melody valve is controversial.…”

“…1 Percutaneous pulmonary valve implantation with the Melody valve is associated with an increased risk of infective endocarditis. [2][3][4][5] The incidence of infective endocarditis in patients after Melody valve is reported to be 3.2-25.0%. 2 Meta-analysis showed higher incidence of infective endocarditis with the Melody valve than Sapien valve (Edwards SAPIEN pulmonic transcatheter heart valve, Edwards Lifesciences, Irvine, California) or surgery.…”

“…2 Meta-analysis showed higher incidence of infective endocarditis with the Melody valve than Sapien valve (Edwards SAPIEN pulmonic transcatheter heart valve, Edwards Lifesciences, Irvine, California) or surgery. 1,[4][5][6][7] However, the management of restenosis of Melody valve with an history of treated infective endocarditis is not clear. This is a case report of a patient who had recurrent infective endocarditis of Melody valve in Melody valve with a new pathogen.…”

New developments in adult congenital heart disease

“…Despite medical advances, the prevalence of endocarditis did not decrease [15]. Although the number of cyanotic patients has reduced, more and more patients receive prosthetic materials, where especially percutaneous pulmonary valve prostheses are associated with increased endocarditis risks [16].…”

Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience

“…John Bradley and Howaida G. El-Said share senior authorship. Division of Cardiovascular Medicine, University of California, San Diego, USA Most studies examining IE after Melody TPV implantation have focused on identifying risk factors associated with developing endocarditis [8][9][10]. This retrospective study aims to identify the factors associated with the need for surgical explantation as opposed to those associated with successful antimicrobial therapy alone.…”