Melioidosis is caused by Gram-negative bacterium Burkholderia pseudomallei. Clinical presentation can vary from pneumonia, sepsis and multi-focal abscess formation. The aim of this study was to systemically review the cardiac manifestations of melioidosis in the literature and describe their epidemiology, microbiological diagnosis and outcomes. A systematic review of the peer-reviewed literature was carried out in PubMed and Google Scholar for human melioidosis cases with cardiac involvement. Quantitative data for cases of melioidosis were obtained, including age, sex, microbiological diagnosis, treatment, and outcome. 980 articles were screened, of which 31 articles were eligible. The most common cardiac site of infection was pericarditis, followed by endocarditis and myocarditis. Over 95% of cardiac involvement occurred in males, and mortality was the lowest in pericarditis and highest in myocarditis. Valvular vegetations were all small, left-sided, and did not require surgery. Antibiotic treatment included a bactericidal induction therapy with ceftazidime or a carbapenem ± TMP-SMX, followed by eradication therapy with TMP–SMX in most patients as previously established. In conclusion, melioidosis varies in clinical presentation and is also known as a great imitator. Although cardiac involvement is rare, this is the first systematic review to summarise all cases reported in the literature to date.

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Background: Recent data suggest that risk of very-late (>1 year) stent thrombosis (ST) may persist in bioresorbable vascular scaffolds (BVS). We performed a meta-analysis to evaluate the safety and efficacy of the commercially available ABSORB BVS compared with everolimus-eluting metallic stents (EES) at mid-term follow-up. Method: Electronic databases and abstracts from international conferences were searched. Inclusion criteria were: (1) randomised trial or comparative observational study, (2) comparison of outcomes between BVS and EES, (3) ≥100 patients treated with BVS, (4) ≥2-year follow-up. Primary endpoint was target lesion failure (TLF); composite of cardiac death, target-vessel myocardial infarction (TV-MI) or ischaemic-driven target lesion revascularisation (ID-TLR). Secondary endpoints included individual TLF components, definite/probable ST and patient-oriented composite endpoint (POCE), consisting of all-cause death, any MI or repeat revascularisation. Summary statistics are reported as pooled odds ratios (OR) with 95% confidence intervals (CI). Results: 3 randomised trials and 2 observational studies met inclusion criteria, with 1,407 patients receiving BVS and 1,095 EES. There was no difference between groups for the primary endpoint of TLF (OR 1.31, 95%CI 0.93-1.83, I 2 = 0%, p = 0.12). However, TV-MI (OR 2.59, 95%CI 1.17-5.70, I 2 = 0%, p = 0.02), ID-TLR (OR 1.70, 95%CI 1.02-2.83, I 2 = 0%, p = 0.04) and ST (OR 2.35, 95%CI 1.14-4.86, I 2 = 0%, p = 0.02) were increased in patients receiving BVS. There was no difference in POCE (OR 1.06, 95%CI 0.67-1.67, I 2 = 54%, p = 0.81). Conclusion: First-generation BVS are associated with increased TV-MI and ID-TLR at mid-term follow-up, although POCE remains equivalent. Further assessment will be required to assess whether the potential benefits of BVS can be realised.

To compare clinical outcomes among three different LAA closure devices. Methods: The consecutive patients who underwent percutaneous LAA closure with Watchman, Amplatzer and WaveCrest were studied. Ischaemic stroke, haemorrhagic stroke, systemic emboli, device-related thrombus, peri-device leak and procedure-related adverse events were evaluated. Results: The consecutive 124 pts (age 75 ± 7; 79 males; CHA2DS2-VASc 4.1 ± 1.4) underwent LAA closure. The closure devices were Amplatzer in 68, Watchman in 37 and WaveCrest in 19. During mean follow-up of 26 ± 18 months, ischaemic stroke occurred in 10 (3.7% per year), haemorrhagic stroke in 2 (0.7% per year) and systemic embolism in 4 (1.5% per year). There was no significant difference in all cause stroke (log-rank p = 0.23) and systemic embolism (log-rank p = 0.22) between the 3 devices. Procedure-related adverse events occurred in 7 (cardiac tamponade: 1, device emboli: 1, haematoma: 5). Device-related thrombus was observed in 4 (10.8%) with Watchman, 1 (5.3%) with WaveCrest and none with Amplatzer (p = 0.026). Peri-device leak >1 mm just after the procedure was detected in 5 (7.4%) with Amplazer, 1 (2.7%) with Watchman and 11 (57.9%) with WaveCrest (p < 0.0001). Conclusion: In this single centre experience, while the incidence of peri-device leaks and device-related thrombus was different among device types, these differences are not associated with an increased risk of all-cause stroke and systemic embolism.