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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
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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
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Copyright
© Cambridge University Press 2016 

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