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Prosthetic pulmonary valve infectious endocarditis in paediatric congenital heart disease patients
Michael J Lewis1,2, Torsten Malm1,3,2, Anna Hallbergson4
1Pediatric Heart Center, Divisions of Pediatric Cardiac Surgery, University Hospital, Lund, Sweden.
Insights
Prosthetic pulmonary valve infection is more common with bovine jugular vein valves than homografts, regardless of surgical or percutaneous pulmonary valve implantation. Bovine jugular vein valves, including Melody valves, showed a higher risk of prosthetic pulmonary valve infectious endocarditis.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiac Surgery
Background:
- Pulmonary valve implantation (PVI) is a common procedure in children with congenital heart disease.
- Surgical PVI (SPVI) was historically the primary method, but percutaneous PVI (PPVI) is increasingly utilized.
Purpose of the Study:
- To compare the incidence of prosthetic pulmonary valve infectious endocarditis (PPVIE) between SPVI and PPVI.
- To evaluate the risk of PPVIE based on the type of pulmonary valve prosthesis used.
Main Methods:
- Retrospective review of pediatric patients who underwent PVI between 1993 and 2022.
- Comparison of PPVIE rates based on intervention method (SPVI vs. PPVI) and prosthesis type (homograft vs. bovine jugular vein).
Main Results:
- Bovine jugular vein (BJV) valves (Contegra and Melody) demonstrated a higher risk of PPVIE compared to homograft valves.
- The incidence of PPVIE was 5.1% for all PVIs, with higher rates for Contegra (1.05%) and Melody (2.93%) valves.
- The material of the prosthesis (BJV vs. homograft) was a more significant factor in PPVIE risk than the method of implantation (SPVI vs. PPVI).
Conclusions:
- Bovine jugular vein pulmonary valve prostheses are more susceptible to infection than homografts, irrespective of the implantation technique.
- Melody valves, despite fewer procedures, showed a trend towards a higher rate of PPVIE.
Objectives:
Pulmonary valve implantation (PVI) is common in children with congenital heart disease particularly as they get older. While surgical PVI (SPVI) was the mainstay of treatment for years, percutaneous PVI (PPVI) has evolved into a popular treatment option. The aim of our study was to evaluate the rate of prosthetic pulmonary valve infectious endocarditis (PPVIE) between these two modes of intervention.
Methods:
Retrospective, single-centre review of paediatric patients at a tertiary referral centre from 1993 to 2022 who underwent PVI. Method of intervention (SPVI vs PPVI) and type of pulmonary valve (PV) prosthesis were used as comparison groups. Occurrence of and time interval to the onset of PPVIE were the primary outcomes of interest.
Results:
There were 467 patients who underwent 686 PVIs (665 SPVI [96.9%] and 21 PPVI [3.1%]). The surgical prostheses were all biologic valved conduits: aortic homograft (118, 17.7%), pulmonary homograft (312, 46.9%) and Contegra (235, 35.3%). The percutaneous prostheses were exclusively Melody valves (21, 100.0%). Incidence of PPVIE was 5.1% (35/689) for all PVIs. Annualized incidence of PPVIE was 0.37% for all PVs; and 0.09% for aortic homografts, 0.14% for pulmonary homografts, 1.05% for Contegra conduits and 2.93% for Melody valves. Freedom from PPVIE (FPI) was 92.1% at 30.9 years after intervention for all PVIs. Bovine jugular vein (BJV) valves (Contegra and Melody) had an increased risk of PPVIE compared with surgically implanted homograft valves. Method of PVI (PPVI vs SPVI) was less important than the material of which the implanted PV prosthesis was constructed (homograft vs BJV graft).
Conclusions:
BJV PV prostheses were more prone to infection than homografts, irrespective of method of implantation. Melody valves, though smaller in number of PVIs performed, displayed a trend toward increased rate of PPVIE.
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