Infective endocarditis after transcatheter versus surgical pulmonary valve replacement in CHD: absolute risk...

As transcatheter pulmonary valve replacement becomes increasingly adopted in children and young adults, concerns regarding infective endocarditis remain a major limitation of this strategy. We performed a systematic review and meta-analysis comparing the risk of infective endocarditis after transcatheter and surgical pulmonary valve replacement.

Comparative studies evaluating infective endocarditis after transcatheter versus surgical pulmonary valve replacement were systematically reviewed. The primary outcome was cumulative infective endocarditis during follow-up; early infective endocarditis was analysed separately. Random-effects models were used to pool odds ratios and absolute risk differences.

Nineteen comparative cohort studies met the inclusion criteria. Fifteen studies contributed long-term data and six reported early events. In the primary long-term analysis (13 studies; 3,917 procedures), transcatheter pulmonary valve replacement was associated with a significantly higher risk of infective endocarditis than surgical pulmonary valve replacement (odds ratio 3.18, 95% confidence interval 2.25-4.49; I² = 0%). The pooled absolute excess risk was 39.2 cases per 1,000 procedures (95% confidence interval 22.7-55.6), corresponding to one additional case for every 26 procedures. Early infective endocarditis did not differ significantly between approaches (odds ratio 1.11, 95% confidence interval 0.33-3.69). Sensitivity analyses yielded consistent results.

Transcatheter pulmonary valve replacement is associated with a higher long-term risk of infective endocarditis than surgical pulmonary valve replacement, whereas evidence for early events remains inconclusive. The observed association is best interpreted in the context of prosthetic material, conduit characteristics, residual haemodynamics, and patient selection rather than as evidence of a purely procedural mechanism.