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Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience
Arpine Davtyan1, Peter W Guyon2, Hannah R El-Sabrout3
1Cardiology, Rady Children's Hospital, University of California San Diego, 3020 Children's Way, MC 5004, San Diego, CA, 92123, USA. adavtyan@health.ucsd.edu.
Pediatric Cardiology
|December 11, 2021
Summary
Management of Melody transcatheter pulmonary valve infective endocarditis often omits surgical removal. Higher peak echo gradients at diagnosis strongly predict the need for valve explantation in these patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Medical Devices
Background:
- Infective endocarditis (IE) guidelines for Melody transcatheter pulmonary valves (TPV) are limited.
- Melody TPV IE presents a unique management challenge, balancing antimicrobial therapy with surgical intervention.
Purpose of the Study:
- To identify factors predicting surgical valve removal versus medical management in Melody TPV IE.
- To analyze outcomes of different treatment strategies for Melody TPV IE.
Main Methods:
- Multicenter retrospective analysis of Melody TPV implants from 2010 to 2019.
- Comparison of surgical explant cases versus non-surgical antimicrobial therapy cases.
- CART analysis to determine key predictors for explantation.
Main Results:
- 8.8% of Melody TPV implants developed IE (66 cases in 59 patients).
- 44% of patients were successfully treated medically without explantation or recurrence.
- Peak echo gradient ≥ 47 mmHg (OR 10.6) and increase > 24 mmHg (OR 6.7) were associated with explantation.
- Explantation rates varied significantly between institutions (27% to 64%).
Conclusions:
- A significant proportion of Melody TPV IE cases can be managed successfully with antimicrobial therapy alone.
- The degree of pulmonary valve stenosis at IE diagnosis is a critical factor in treatment decisions.
- Standardized management protocols for Melody TPV IE are needed, considering institutional variations.
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