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Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
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Outcomes of Treatment for Infective Endocarditis Following Transcatheter Pulmonary Valve Replacement
J Chancellor Fox1,2, Horacio G Carvajal1,2, Fei Wan3
1Department of Surgery, Division of Cardiothoracic Surgery, 12275Washington University School of Medicine, St. Louis, MO, USA.
World Journal for Pediatric & Congenital Heart Surgery
|February 27, 2023
Summary
Infective endocarditis (IE) after transcatheter pulmonary valve replacement (TPVR) can lead to relapses with medical therapy alone. Surgery appears most effective for IE treatment, though associated mortality is higher in this TPVR patient group.
Area of Science:
- Cardiology
- Infectious Diseases
- Surgical Outcomes
Background:
- Transcatheter pulmonary valve replacement (TPVR) recipients face an elevated risk of infective endocarditis (IE).
- Limited data exist on managing IE post-TPVR, especially regarding surgical interventions.
Purpose of the Study:
- To evaluate outcomes of different management strategies for IE in patients who have undergone TPVR.
- To compare the effectiveness and complications of surgical versus medical-only therapy for IE after TPVR.
Main Methods:
- A retrospective analysis of the Pediatric Health Information System database (2010-2020) was conducted.
- Identified IE cases post-TPVR, detailing demographics, hospital course, complications, and treatment outcomes.
- Compared outcomes based on initial surgical or medical-only therapy.
Main Results:
- Sixty-nine IE cases were identified, with 29% experiencing IE-related readmissions.
- Initial medical therapy alone resulted in a 33% relapse rate.
- Surgical intervention rates were 22% initially and 36% overall; surgery was more common with subsequent admissions.
- Renal and respiratory failure were more frequent in the initial surgery group. Overall mortality was 4.3%, with 8% in the surgical cohort.
Conclusions:
- Initial medical therapy for IE post-TPVR may lead to relapses and delayed surgical treatment.
- Surgical intervention appears most effective for IE treatment, despite higher associated mortality.
- More aggressive medical therapy might be needed for patients treated non-surgically to prevent relapse.
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