Bloodstream Infections Occurring in Patients With Percutaneously Implanted Bioprosthetic Pulmonary Valve
- 1 June 2013
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Circulation: Cardiovascular Interventions
- Vol. 6 (3), 301-310
- https://doi.org/10.1161/circinterventions.112.000348
Abstract
Background— Percutaneous pulmonary valve implantation using a stent-based bioprosthetic valve provides an alternative to surgery in select patients. Systemic infections in Melody valve–implanted patients with and without identified valve involvement have been reported, yet the incidence is unknown, and risk factors remain unidentified. Methods and Results— Between 2007 and 2012, a total of 147 consecutive patients with congenital heart disease underwent Melody percutaneous pulmonary valve implantation at our institution. Demographic and clinical variables were collected at baseline and at follow-up and analyzed as predictors. The occurrence of bloodstream infection (BSI), defined as a bacterial infection treated with ≥4 weeks of antibiotics, served as our primary outcome. The mean age at implantation for the study population was 21.5±11 years, and tetralogy of Fallot was the cardiac condition in 59%. During a median follow-up of 19 months, 14 patients experienced BSI (9.5%; 95% confidence interval, 5.3%–15%). Of these, 4 (2.7%) patients had Melody valve endocarditis. Two patients died during the event, neither of whom had known valve involvement. The median procedure to infection time was 15 months (range, 1–56). In univariate analysis, male sex, previous endocarditis, in situ stents in the right ventricular outflow tract, and presence of outflow tract irregularities at the implant site were associated with BSI occurrence. Conclusions— In this cohort, 9.5% of patients who underwent Melody percutaneous pulmonary valve implantation experienced subsequent BSI, occurring 1 to 56 months after implant, and 2.7% of patients had prosthetic endocarditis. Our findings suggest that patient and nonvalve anatomic factors may be associated with BSI after percutaneous pulmonary valve implantation.Keywords
This publication has 26 references indexed in Scilit:
- Early Versus Late Functional Outcome After Successful Percutaneous Pulmonary Valve Implantation: Are the Acute Effects of Altered Right Ventricular Loading All We Can Expect?Journal of the American College of Cardiology, 2011
- Short- and Medium-Term Outcomes After Transcatheter Pulmonary Valve Placement in the Expanded Multicenter US Melody Valve TrialCirculation, 2010
- Delayed improvement of right ventricular diastolic function and regression of right ventricular mass after percutaneous pulmonary valve implantation in patients with congenital heart diseaseAmerican Heart Journal, 2009
- Physiological and Clinical Consequences of Relief of Right Ventricular Outflow Tract Obstruction Late After Repair of Congenital Heart DefectsCirculation, 2006
- Update on Infective EndocarditisCurrent Problems in Cardiology, 2006
- Prosthetic Valve EndocarditisThe Annals of Thoracic Surgery, 2005
- Prosthetic valve endocarditis: who needs surgery? A multicentre study of 104 casesHeart, 2005
- Tissue engineering heart valves: Valve leaflet replacement study in a lamb modelThe Annals of Thoracic Surgery, 1995
- Prosthetic valve endocarditisThe Journal of Thoracic and Cardiovascular Surgery, 1986
- Complications of Artificial Heart ValvesJAMA, 1979