Infective Endocarditis in Percutaneous Pulmonary Revalvulation: a Direct Comparison Between Melody and Sapien Valves

Infective endocarditis (IE) is a dreaded complication in patients with congenital heart disease (CHD), with an incidence up to 100-fold compared to the general population. In CHD such as cono-truncal defects, the right ventricular outflow tract (RVOT) is reconstructed using patches, conduits, homografts or bioprosthetic valves. Subsequently, pulmonary regurgitation, conduit degeneration, or conduit mismatch due to growth may require repeated valve and/or conduit replacement. Transcatheter pulmonary valve implantation (TPVI) is an effective treatment for RVOT dysfunction, as an alternative to surgical pulmonary valve replacement. TPVI was first described in 2000 and, since then, many studies have supported its safety and efficacy. The MELODY valve (Medtronic Inc., Minneapolis, MN) was used first and received European certification in 2006 and FDA approval in 2010. The SAPIEN valve series (Edwards SAPIEN pulmonic transcatheter heart valve, and SAPIEN 3 valve, Edwards Lifesciences, Irvine, CA) were subsequently licensed for TPVI (Europe 2010; and FDA, 2016). The feasibility of TPVI was initially demonstrated in right ventricle-to-pulmonary artery conduits and then in bioprostheses, small expandable conduits, and native or patched RVOTs. IE after TPVI (TPVI-IE) remains a life-threatening adverse event that affects valve durability and patient outcomes. National and international recommendations provide only meager guidance about the management of TPVI-IE. A history of IE, Di George syndrome, male sex, younger age at implant and increased valve gradient have been identified as risk factors for IE. However it remains a matter of debate whether the type of valve influences the risk of IE. Although the bovine jugular vein valves like the MELODY valve and the CONTEGRA conduit are mentioned as specific risk factors for IE in the German guidelines for IE, other authors did not support this in a large multicentre study. An important limitation is that most of studies had limited duration of follow-up, particularly after SAPIEN-TPVI, whereas endocarditis has been equally described many years following TPVI. The objective of this study was to identify additional risk factors for TPVI-IE over the long-term.

METHODS A retrospective study of the multicentre international ENDOCPULM registry including consecutive patients after successful MELODY and SAPIEN-TPVI between 2007 and 2021 in 35 tertiary European and Middle-East centres was designed. The study was approved by an independent ethics committee (GERM IRB 00012157, #552, December 17th, 2021) and was performed in accordance with the Declaration of Helsinki and its amendments. This report complies with STROBE guidelines for cohort studies.