Hostname: page-component-586b7cd67f-g8jcs Total loading time: 0 Render date: 2024-11-23T03:35:29.351Z Has data issue: false hasContentIssue false
  • English
  • Français

Infective endocarditis following Melody valve implantation: comparison with a surgical cohort

Published online by Cambridge University Press:  10 May 2016

Clare O’Donnell ,
Rhonda Holloway ,
Elizabeth Tilton ,
John Stirling ,
Kirsten Finucane  and
Nigel Wilson
Clare O’Donnell*
Affiliation:
Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland, New Zealand
Rhonda Holloway
Affiliation:
Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland, New Zealand
Elizabeth Tilton
Affiliation:
Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland, New Zealand
John Stirling
Affiliation:
Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland, New Zealand
Kirsten Finucane
Affiliation:
Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland, New Zealand
Nigel Wilson
Affiliation:
Green Lane Paediatric and Congenital Cardiac Service, Starship Children’s Hospital, Auckland, New Zealand
*
Correspondence to: C. O’Donnell, MBChB SM, FRACP, Green Lane Paediatric and Congenital Cardiac Service, Starship/Auckland City Hospitals, Starship Children’s Hospital, Private Bag 92024, Victoria Street West, Auckland 1142, New Zealand. Tel: +64 9 307 4949 ext 23642/23617; Fax: +64 9 375 7026; E-mail: ClareOD@adhb.govt.nz
Get access Rights & Permissions [Opens in a new window]

Abstract

Background

Infective endocarditis has been reported post Melody percutaneous pulmonary valve implant; the incidence and risk factors, however, remain poorly defined. We identified four cases of endocarditis from our first 25 Melody implants. Our aim was to examine these cases in the context of postulated risk factors and directly compare endocarditis rates with local surgical valves.

Methods

We conducted a retrospective review of patients post Melody percutaneous pulmonary valve implant in New Zealand (October, 2009–May, 2015) and also reviewed the incidence of endocarditis in New Zealand among patients who have undergone surgical pulmonary valve implants.

Results

In total, 25 patients underwent Melody implantation at a median age of 18 years. At a median follow-up of 2.9 years, most were well with low valve gradient (median 27 mmHg) and only mild regurgitation. Two patients presented with life-threatening endocarditis and obstructive vegetations at 14 and 26 months post implant, respectively. Two additional patients presented with subacute endocarditis at 5.5 years post implant. From 2009 to May, 2015, 178 surgical pulmonic bioprostheses, largely Hancock valves and homografts, were used at our institution. At a median follow-up of 2.9 years, four patients (2%) had developed endocarditis in this group compared with 4/25 (16%) in the Melody group (p=0.0089). Three surgical valves have been replaced.

Conclusions

The Melody valve offers a good alternative to surgical conduit replacement in selected patients. Many patients have excellent outcomes in the medium term. Endocarditis, however, can occur and if associated with obstruction can be life threatening. The risk for endocarditis in the Melody group was higher in comparison with that in a contemporaneous surgical pulmonary implant cohort.

Keywords

Transcatheter valvefollow-upcongenital intervention
Type
Original Articles
Information
Cardiology in the Young , Volume 27 , Issue 2 , March 2017 , pp. 294 - 301
Check for updates
Copyright
© Cambridge University Press 2016 

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

References

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.Google Scholar
2. 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.Google Scholar
3. Bhat, DP, Forbes, TJ, Aggarwal, S. A case of life-threatening Staphylococcus aureus endocarditis involving percutaneous transcatheter prosthetic pulmonary valve. Congenit Heart Dis 2013; 8: E161–E164.Google Scholar
4. Buber, J, Bergersen, L, Lock, JE, et al. Bloodstream infections occurring in patients with percutaneously implanted bioprosthetic pulmonary valve: a single-center experience. Circ Cardiovasc Interv 2013; 6: 301–310.CrossRefGoogle ScholarPubMed
5. McElhinney, DB, Benson, LN, Eicken, A, et al. Infective endocarditis after transcatheter pulmonary valve replacement using the Melody valve: combined results of 3 prospective North American and European studies. Circ Cardiovasc Interv 2013; 6: 292–300.CrossRefGoogle ScholarPubMed
6. Patel, M, Iserin, L, Bonnet, D, Boudjemline, Y. Atypical malignant late infective endocarditis of Melody valve. J Thorac Cardiovasc Surg 2012; 143: e32–e35.Google Scholar
7. Cheung, G, Vejlstrup, N, Ihlemann, N, et al. Infective endocarditis following percutaneous pulmonary valve replacement: diagnostic challenges and application of intra-cardiac echocardiography. Int J Cardiol 2013; 169: 425–429.Google Scholar
8. Malekzadeh-Milani, S, Ladouceur, M, Patel, M, et al. Incidence and predictors of Melody® valve endocarditis: a prospective study. Arch Cardiovasc Dis 2015; 108: 97–106.Google Scholar
9. Schneider, H, Vogt, M, Boekenkamp, R, et al. Melody transcatheter valve: histopathology and clinical implications of nine explanted devices. Int J Cardiol 2015; 189: 124–131.CrossRefGoogle ScholarPubMed
10. Villafane, J, Baker, GH, Austin, EH 3rd, et al. Melody pulmonary valve bacterial endocarditis: experience in four pediatric patients and a review of the literature. Catheter Cardiovasc Interv 2014; 84: 212–218.Google Scholar
11. Lurz, P, Coats, L, Khambadkone, S, et al. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation 2008; 117: 1964–1972.Google Scholar
12. Eicken, A, Ewert, P, Hager, A, et al. Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients. Eur Heart J 2011; 32: 1260–1265.Google Scholar
13. Nordmeyer, J, Khambadkone, S, Coats, L, et al. Risk stratification, systematic classification, and anticipatory management strategies for stent fracture after percutaneous pulmonary valve implantation. Circulation 2007; 115: 1392–1397.CrossRefGoogle ScholarPubMed
14. Fraisse, A, Aldebert, P, Malekzadeh-Milani, S, et al. Melody® transcatheter pulmonary valve implantation: results from a French registry. Arch Cardiovasc Dis 2014; 107: 607–614.Google Scholar
15. Cheatham, JP, Hellenbrand, WE, Zahn, EM, et al. Clinical and hemodynamic outcomes up to 7 years after transcatheter pulmonary valve replacement in the US melody valve investigational device exemption trial. Circulation 2015; 131: 1960–1970.Google Scholar
16. Nordmeyer, J, Lurz, P, Tsang, VT, et al. Effective transcatheter valve implantation after pulmonary homograft failure: a new perspective on the Ross operation. J Thorac Cardiovasc Surg 2009; 138: 84–88.Google Scholar
17. Gillespie, MJ, McElhinney, DB, Kreutzer, J, et al. Transcatheter pulmonary valve replacement for right ventricular outflow tract conduit dysfunction after the Ross procedure. Ann Thorac Surg 2015; 100: 996–1003.Google Scholar
18. Butera, G, Milanesi, O, Spadoni, I, et al. Melody transcatheter pulmonary valve implantation. Results from the registry of the Italian Society of Pediatric Cardiology. Catheter Cardiovasc Interv 2013; 81: 310–316.Google Scholar