Occurrence and Outcome of Infective Endocarditis after Surgical Compared to Transcatheter Pulmonary Valve Implantation in Congenital Heart Disease

• Published in: Journal of clinical medicine Vol. 13; no. 9; p. 2683
• Main Authors: Fischer, Alicia Jeanette, Enders, Dominic, Baumgartner, Helmut, Diller, Gerhard-Paul, Kaleschke, Gerrit
• Format: Journal Article
• Language: English
• Published: Switzerland MDPI AG 01-05-2024
• Subjects: Cardiovascular disease; Care and treatment; Congenital diseases; Congenital heart disease; Datasets; Diagnosis; Endocarditis; Fatalities; Genetic disorders; Health insurance; Health insurance industry; Heart; Infective endocarditis; Intervention; Patient outcomes; Patients; Risk factors; Surgery; Germany; heart valve prosthesis; pulmonary valve; endocarditis; cardiac surgical procedures; congenital heart defect
• ISSN: 2077-0383; 2077-0383
• DOI: 10.3390/jcm13092683

: Conflicting data exist on the occurrence and outcome of infective endocarditis (IE) after pulmonary valve implantation. Objectives: This study sought to assess the differences between transcatheter pulmonary valve implantation (TPVI) and surgical pulmonary valve replacement (SPVR).
: All patients ≥ 4 years who underwent isolated pulmonary valve replacement between 2005 and 2018 were analyzed based on the data of a major German health insurer (≈9.2 million insured subjects representative of the German population). The primary endpoint was a composite of IE occurrence and all-cause death.
: Of 461 interventions (cases) in 413 patients (58.4% male, median age 18.9 years [IQR 12.3-33.4]), 34.4% underwent TPVI and 65.5% SPVR. IE was diagnosed in 8.0% of cases during a median follow-up of 3.5 years. Risk for IE and all-cause death was increased in patients with prior IE (
< 0.001), but not associated with age (
= 0.50), sex (
= 0.67) or complexity of disease (
= 0.59). While there was no difference in events over the entire observational time period (
= 0.22), the time dynamics varied between TPVI and SPVR: Within the first year, the risk for IE and all-cause death was lower after TPVI (Hazard Ratio (HR) 95% CI 0.19 (0.06-0.63;
= 0.006) but increased over time and exceeded that of SPVR in the long term (HR 10.07 (95% CI 3.41-29.76;
< 0.001).
: Patients with TPVI appear to be at lower risk for early but higher risk for late IE, resulting in no significant difference in the overall event rate compared to SPVR. The results highlight the importance of long-term specialized care and preventive measures after both interventions.