Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2019 Oct 1;94(4):625-635.
doi: 10.1002/ccd.28474. Epub 2019 Aug 30.

Risk factors for infective endocarditis following transcatheter pulmonary valve replacement in patients with congenital heart disease

Soraya Sadeghi  1 , Subeer Wadia  1 , Gentian Lluri  1 , Jana Tarabay  1 , Anisha Fernando  1 , Morris Salem  2 , Sanjay Sinha  3 , Daniel S Levi  1   3 , Jamil Aboulhosn  1   3
Affiliations

Risk factors for infective endocarditis following transcatheter pulmonary valve replacement in patients with congenital heart disease

Soraya Sadeghi et al. Catheter Cardiovasc Interv. .

Abstract

Objectives: We sought to delineate the risk factors for infective endocarditis (IE) in patients undergoing transcatheter pulmonary valve replacement (TCPVR).

Background: Despite the therapeutic benefits of TCPVR for treatment of dysfunctional right ventricular outflow tracts, IE is a major complication of the approach. Specific hemodynamic gradients and patient immune status as predisposing factors for IE are largely unexplored.

Methods: We performed a retrospective review of patients who had undergone TCPVR at UCLA between October 2010 and October 2017. Cases of IE were diagnosed based on the modified Duke criteria.

Results: Two hundred and thirty-five cases of TCPVR were performed with a mean follow-up of 2.6 years (range 0.0-8.0 years). Sixteen distinct IE events developed in 13 patients (Melody™ n = 12, SAPIEN n = 1), with a median time from implant to IE of 3.3 years (range 2.0-7.2 years). Univariate Cox regression showed that immunocompromised status was significantly associated with the development of IE hazard ratios (HR 5.43 [1.80-16.4], p = .003). Kaplan-Meier curves show that the 5-year freedom from IE among immunocompetent patients was 87% (95% CI 78-96%) versus 64% (95% CI 39-89%) among immunocompromised patients (log-rank p = .02). Postimplant right ventricular systolic pressure was higher among immunocompromised patients (p = .03). The risk of IE post-TCPVR in immunocompromised patients with residual pulmonary stenosis was 43%.

Conclusions: Among the risk factors examined in this study, immunocompromised status was the most significant predictor of IE development post-TCPVR. Patients with the lowest risk of IE are those with competent immune systems, without a history of IE, and with minimal residual pulmonary valve gradients post-TCPVR.

Keywords: IE; TCPVR complications; pulmonary valve disease.

PubMed Disclaimer

References

REFERENCES

    1. Khairy P, Aboulhosn J, Gurvitz MZ, et al. Arrythmia burden in adults with surgically repaired tetralogy of Fallot: a multi-institutional study. Circulation. 2010;122:868-875.
    1. Bonhoeffer P, Boudjemline Y, Saliba Z, et al. Percutaneous replacement of pulmonary valve in a right-ventricle to pulmonary-artery prosthetic conduit with valve dysfunction. Lancet. 2000;356:1403-1405.
    1. Lluri G, Levi DS, Miller E, et al. Incidence and outcome of infective endocarditis following percutaneous versus surgical pulmonary valve replacement. Catheter Cardiovasc Interv. 2018;91:277-284.
    1. McElhinney DB, Sondergaard L, Armstrong AK, et al. Endocarditis after transcatheter pulmonary valve replacement. J Am Coll Cardiol. 2018;72:2717-2728.
    1. Van Dijck I, Budts W, Cools B, et al. Infective endocarditis of a transcatheter pulmonary valve in comparison with surgical implants. Heart. 2015;101:788-793.

MeSH terms

LinkOut - more resources