Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients

Eicken, Andreas; Ewert, Peter; Hager, Alfred; Peters, Bjoern; Fratz, Sohrab; Küehne, Titus; Busch, Raymonde; Hess, John; Berger, Felix

doi:10.1093/eurheartj/ehq520

Cited by 272 publications

(228 citation statements)

References 26 publications

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“…In the more contemporary TPVI experience, with the adoption of routine prestenting, reintervention attributable to recurrent valve obstruction became uncommon 4, 24, 61, 62. In the present review, a strong association between IE and Melody valve obstructive dysfunction was obviated.…”

Section: Discussionmentioning

confidence: 59%

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

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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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.

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Section: Discussionmentioning

confidence: 59%

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

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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“…(20) Freedom from valve dysfunction or re-operation ranged from 95 -100% at one year to 70% at seventy months during followup. (8,14,15) These results provide evidence that the initial aim of prolonging the life-span of surgically placed right ventricular outflow tract conduits can be successfully achieved by the implantation of a percutaneous valve.…”

Section: Coronary Compression Was Responsible For Virtually All Deathsmentioning

confidence: 73%

“…Major procedural complications included dislodgement of the valve, coronary compression, rupture of homograft and haemothorax due to pulmonary artery perforations. (7,(13)(14)(15)(16)(17)(18) Dislodgement of the device occurred mostly during the initial development phase and could be related to operator inexperience as well as the early learning curve. It is now extremely rare, especially with pre-stenting.…”

Section: Outcomes Of Percutaneous Pulmonary Valve Implantationmentioning

confidence: 99%

“…The most common complication has been stent fractures which occurred in 5% to 30% of cases. (14,15,19) Although the vast majority of stent fractures remain asymptomatic, it may lead to the development of outflow tract gradients. However, this can easily be treated with the implantation of another percutaneous valve.…”

Section: Coronary Compression Was Responsible For Virtually All Deathsmentioning

confidence: 99%

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Right ventricular outfl ow tract revalvulation using the Melody Valve: The next frontier

Buys

Brown

2017

SAHJ

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Right ventricular outfl ow tract revalvulation using the Melody Valve: The next frontier in terms of years of freedom from re-operation. Freedom from re-operation varies (see Table I) with rates of 97% at one year to, on average, 70% and 31% after 10 and 15 years respectively.(1-3) Low body weight, younger age at insertion, small size grafts and longer cross-clamping times are factors associated with early graft failure.(1,4) It has been estimated that these patients may require up to 5 conduit revisions over a lifetime.Multiple conduit revisions in these patients often result in prolonged hospital stays, increased morbidity and mortality due to the fact that difficulty of surgery increases with every re-operation. This may result in a considerable increase in medical costs and a negative impact on quality of life. Nevertheless, surgery has good long term survival and should be considered as the gold standard of treatment. PERCUTANEOUS RVOT REVALVULATIONUntil recently, surgery was the only option for managing RVOT dysfunction. The first percutaneous pulmonary valve was implanted

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“…In the 1-to 4-year postoperative period, IE after TPVR has been documented in <3% of patients; however, this may be a significant underestimation given the lack of long-term follow-up PEDIATRICS Volume 137 , number 1 , January 2016 data in this population. [4][5][6][7][8][9] In one recent prospective study, 5 (6%) of 86 patients who underwent Melody TPVR from 2009 to 2012 developed IE after 2.6 to 28.0 months of follow-up. All cases had a history of fever and demonstrated a sudden increase in RVOT gradient on echocardiogram.…”

Section: Discussionmentioning

confidence: 99%

Melody Valve Bartonella henselae Endocarditis in an Afebrile Teen: A Case Report

et al. 2016

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Significant advancements in the care of children with cardiac valve disease over the past 15 years have led to the increasingly common use of percutaneous transcatheter valve implantation as an alternative to surgical replacement in selected patient populations. Although the transcatheter approach has several advantages, this approach and the valves used are not without complications. Bacterial endocarditis is a known and concerning complication after transcatheter pulmonary valve replacement (TPVR). Most reported cases have involved organisms that are common etiologic agents of bacterial endocarditis and are readily identified via blood culture. However, culture-negative endocarditis in the setting of TPVR has not been well described. We present our experience with one afebrile teenager with culture-negative, serology-positive Bartonella henselae endocarditis of a Melody valve 18 months after TPVR for management of tetralogy of Fallot. The teen was successfully managed with long-term antibiotic therapy followed by surgical replacement of the valve. To our knowledge, this is the first reported case of culture-negative endocarditis of a Melody TPVR in the absence of fever. This report discusses the importance of considering culture-negative endocarditis in the differential diagnosis of an afebrile patient with TPVR presenting with constitutional symptoms and valve dysfunction, particularly in the primary care setting. It is anticipated that with an increase in the successfully aging population of children who have undergone cardiac repair, the evaluation of these patients will become an increasingly important and common task for the community pediatrician.

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Percutaneous pulmonary valve implantation: two-centre experience with more than 100 patients

Cited by 272 publications

References 26 publications

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

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

Right ventricular outfl ow tract revalvulation using the Melody Valve: The next frontier

Melody Valve Bartonella henselae Endocarditis in an Afebrile Teen: A Case Report

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