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Multicenter Study
. 2022 Apr;43(4):894-902.
doi: 10.1007/s00246-021-02801-z. Epub 2021 Dec 11.

Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience

Arpine Davtyan  1 , Peter W Guyon  2 , Hannah R El-Sabrout  3 , Reid Ponder  3 , Nanda Ramchandar  4 , Rachel Weber  2 , Wagih Zayed  2 , Kanishka Ratnayaka  2 , John J Nigro  5 , John W Moore  2 , Holly Bauser-Heaton  6 , Laith Alshawabkeh  7 , Ryan R Reeves  7 , Daniel Levi  3 , Jamil Aboulhosn  3 , Henri Justino  8 , John Bradley  4 , Howaida G El-Said  2
Affiliations
Multicenter Study

Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience

Arpine Davtyan et al. Pediatr Cardiol. 2022 Apr.

Abstract

Guidelines for management of Melody transcatheter pulmonary valve (TPV) infective endocarditis (IE) are lacking. We aimed to identify factors associated with surgical valve removal versus antimicrobial therapy in Melody TPV IE. Multicenter retrospective analysis of all patients receiving Melody TPV from 10/2010 to 3/2019 was performed to identify cases of IE. Surgical explants versus non-surgical cases were compared. Of the 663 Melody TPV implants, there were 66 cases of IE in 59 patients (59/663, 8.8%). 39/66 (59%) were treated with IV antimicrobials and 27/66(41%) underwent valve explantation. 26/59 patients (44%) were treated medically without explantation or recurrence with average follow-up time of 3.5 years (range:1-9). 32% of Streptococcus cases, 53% of MSSA, and all MRSA cases were explanted. 2 of the 4 deaths had MSSA. CART analysis demonstrated two important parameters associated with explantation: a peak echo gradient ≥ 47 mmHg at IE diagnosis(OR 10.6, p < 0.001) and a peak echo gradient increase of > 24 mmHg compared to baseline (OR 6.7, p = 0.01). Rates of explantation varied by institution (27 to 64%). In our multicenter experience, 44% of patients with Melody IE were successfully medically treated without valve explantation or recurrence. The degree of valve stenosis at time of IE diagnosis was strongly associated with explantation. Rates of explantation varied significantly among the institutions.

Keywords: Congenital heart disease; Endocarditis; Melody valve; Transcatheter pulmonary valve.

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Conflict of interest statement

The authors have no conflict of interest to disclose.

Figures

Fig. 1
Fig. 1
Outcomes after Melody Valve Infective Endocarditis. *One of these patients had MSSA endocarditis and removal of the Melody valve. Three years later, the patient had a second Melody valve implanted within his homograft. The patient developed MSSA endocarditis about two months after placement of the second valve. This was treated with IV antimicrobials. Three years later the patient had a third episode of MSSA endocarditis and the valve was explanted
Fig. 2
Fig. 2
Forest plot of odds ratios and the 95% confidence interval for baseline characteristics and risk factors for Melody Valve explantation
Fig. 3
Fig. 3
CART analysis inflection points. Blue diamonds represent patients whose Melody Valve was not explanted. The yellow circles represent patients whose valves were removed. The dotted lines are drawn at the inflection points identified by CART analysis (47 mmHg for the peak gradient across the RVOT at diagnosis and 24 mmHg for the change in peak gradient compared to baseline)
Fig. 4
Fig. 4
Proposed clinical framework
See this image and copyright information in PMC

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