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

Abstract

BackgroundInfective 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.Methods and ResultsPubMed, 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%; P=0.042) and in patients with non‐streptococcal IE (73% versus 30%; P=0.001).ConclusionsThe 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.

Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia

“…An in vitro study showed selective adhesion of bacteria to healthy Melody valve tissue (Jalal et al, 2015). The usual microorganisms involved in post-TPVI infective endocarditis are Staphylococci (42% of cases) and Streptococci (30% of cases) (Abdelghani et al, 2018). These values are similar to those observed in prosthetic valve endocarditis cases.…”

“…Several studies have confirmed the safety of TPVI and the durability of the implant (Patel et al, 2014). However, these benefits are offset by recent reports showing IE after Melody valve implantation (Hascoet et al, 2017;Patel et al, 2014;Abdelghani et al, 2018;Malekzadeh-Milani et al, 2018). The incidence rate of TPVI-related IE varied between 3.5% and 25% in one systemic review, with an annualized rate of 1.3-9.1% per patient-year (Abdelghani et al, 2018).…”

Recurrent infective endocarditis in a patient after a second Melody valve placement

“…The cumulative incidence of infective endocarditis after the Melody valve is reported to be from 3.2% to 25.0%. 2 Thirty-two percent of cases of infective endocarditis occur within 1 year after percutaneous pulmonary valve implantation, 27% occurs in the second year, 18 % occurs in the third year, and 23% occurs beyond 3 years after the procedure. Authors suggested this reflects the fact that the risk is likely not attributable only to surgical factors associated with implantation but also to the mere long-term presence of the protheses.…”

“…1 Percutaneous pulmonary valve implantation with the Melody valve is associated with an increased risk of infective endocarditis. [2][3][4][5] The incidence of infective endocarditis in patients after Melody valve is reported to be 3.2-25.0%. 2 Meta-analysis showed higher incidence of infective endocarditis with the Melody valve than Sapien valve (Edwards SAPIEN pulmonic transcatheter heart valve, Edwards Lifesciences, Irvine, California) or surgery.…”

“…[2][3][4][5] The incidence of infective endocarditis in patients after Melody valve is reported to be 3.2-25.0%. 2 Meta-analysis showed higher incidence of infective endocarditis with the Melody valve than Sapien valve (Edwards SAPIEN pulmonic transcatheter heart valve, Edwards Lifesciences, Irvine, California) or surgery. 1,[4][5][6][7] However, the management of restenosis of Melody valve with an history of treated infective endocarditis is not clear.…”