Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

• Published in: Journal of the American Heart Association 2018-06, Vol.7 (13)
• Main Authors: Abdelghani, Mohammad, Nassif, Martina, Blom, Nico A, Van Mourik, Martijn S, Straver, Bart, Koolbergen, David R, Kluin, Jolanda, Tijssen, Jan G, Mulder, Barbara J M, Bouma, Berto J, de Winter, Robbert J
• Format: Article
• Language: English
• Subjects: Adolescent; Adult; Bioprosthesis - adverse effects; Child; Child, Preschool; congenital heart disease; endocarditis; Endocarditis - diagnosis; Endocarditis - epidemiology; Endocarditis - mortality; Endocarditis - therapy; Female; Heart Valve Prosthesis - adverse effects; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - instrumentation; Heart Valve Prosthesis Implantation - mortality; Humans; Incidence; Male; Melody valve; Middle Aged; percutaneous pulmonary valve implantation; percutaneous valve; Prosthesis Design; Prosthesis-Related Infections - diagnosis; Prosthesis-Related Infections - epidemiology; Prosthesis-Related Infections - mortality; Prosthesis-Related Infections - therapy; pulmonary valve; Pulmonary Valve - surgery; Risk Assessment; Risk Factors; Systematic Review and Meta‐Analysis; Time Factors; Treatment Outcome; Young Adult
• ISSN: 2047-9980; 2047-9980
• DOI: 10.1161/JAHA.117.008163

Infective endocarditis (IE) after transcatheter pulmonary valve implantation (TPVI) in dysfunctioning right ventricular outflow tract conduits has evoked growing concerns. We aimed to investigate the incidence and the natural history of IE after TPVI with the Melody valve through a systematic review of published data. PubMed, EMBASE, and Web of Science databases were systematically searched for articles published until March 2017, reporting on IE after TPVI with the Melody valve. Nine studies (including 851 patients and 2060 patient-years of follow-up) were included in the analysis of the incidence of IE. The cumulative incidence of IE ranged from 3.2% to 25.0%, whereas the annualized incidence rate ranged from 1.3% to 9.1% per patient-year. The median (interquartile range) time from TPVI to the onset of IE was 18.0 (9.0-30.4) months (range, 1.0-72.0 months). The most common findings were positive blood culture (93%), fever (89%), and new, significant, and/or progressive right ventricular outflow tract obstruction (79%); vegetations were detectable on echocardiography in only 34% of cases. Of 69 patients with IE after TPVI, 6 (8.7%) died and 35 (52%) underwent surgical and/or transcatheter reintervention. Death or reintervention was more common in patients with new/significant right ventricular outflow tract obstruction (69% versus 33%; =0.042) and in patients with non-streptococcal IE (73% versus 30%; =0.001). The incidence of IE after implantation of a Melody valve is significant, at least over the first 3 years after TPVI, and varies considerably between the studies. Although surgical/percutaneous reintervention is a common consequence, some patients can be managed medically, especially those with streptococcal infection and no right ventricular outflow tract obstruction.