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<p>This study compared medical therapy versus combined medical-surgical therapy of infective endocarditis (IE) after transcatheter pulmonary valve replacement (tPVR).&#xa0;Patients who underwent tPVR between January 2008 and May 2022 were included in the study. Endocarditis was confirmed using the modified Duke Criteria. Medical therapy compared with medical-surgical therapy.&#xa0;A total of 387 patients underwent 404 tPVR procedures, 276 received Melody valves and 128 received Sapien valves. The cohort, 65% male with median age 19 years, was followed for 3,053 patient-years. Of these, 26 developed endocarditis. The annualized incidence rate of IE was 7.79 cases per 1000 patient-years (95% confidence interval (CI): 2.51–24.17) at 1 year and 6.96 cases per 1000 patient-years (95%CI: 3.75–12.94) at 5 years. Melody valve was associated with a significantly higher risk of IE than Sapien valve (11.40 vs. 2.90 per 1000 patient-years; incidence rate ratio (IRR) 3.94; <i>p</i> = 0.0058); this was confirmed in the reduced Cox proportional hazards model, HR 3.81 (95%CI: 1.12–12.91). Patients with IE were younger than those without IE (<i>p</i> = 0.017), and 77% of cases with IE received medical therapy whilst 23% received medical-surgical therapy. Among medically treated patients, 55% needed catheter re-intervention. The medical-surgical group experienced more severe symptoms, including increased pulmonary valve stenosis. Methicillin-resistant Staphylococcus aureus, Coxiella burnetii, and Streptococcus gordonii together accounted for 65% of cases.&#xa0;Medical therapy is effective for uncomplicated tPVR-endocarditis. The Melody valve has nearly fourfold higher endocarditis rate and increased mortality. Therefore, pre-implant assessment is recommended for younger high-risk patients.</p>

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Medical Versus Surgical Therapy of Infected Percutaneous Pulmonary Valve

  • 期刊论文

  • 发表日期：

    2026年3月26日

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  • Mansour Bdyee ALJufan,
  • Muhammad Saleem,
  • Abdulai Agbor Yansaneh,
  • Felix Wang Tsai,
  • Fadel Abdulmohssen ALFadely,
  • Feras Alhazmi,
  • Khaled ALtuwariqi,
  • Naheel Abdelbaky,
  • Hajer Ali Rezaiqi,
  • Abdalkareem AlAllaf

摘要

This study compared medical therapy versus combined medical-surgical therapy of infective endocarditis (IE) after transcatheter pulmonary valve replacement (tPVR). Patients who underwent tPVR between January 2008 and May 2022 were included in the study. Endocarditis was confirmed using the modified Duke Criteria. Medical therapy compared with medical-surgical therapy. A total of 387 patients underwent 404 tPVR procedures, 276 received Melody valves and 128 received Sapien valves. The cohort, 65% male with median age 19 years, was followed for 3,053 patient-years. Of these, 26 developed endocarditis. The annualized incidence rate of IE was 7.79 cases per 1000 patient-years (95% confidence interval (CI): 2.51–24.17) at 1 year and 6.96 cases per 1000 patient-years (95%CI: 3.75–12.94) at 5 years. Melody valve was associated with a significantly higher risk of IE than Sapien valve (11.40 vs. 2.90 per 1000 patient-years; incidence rate ratio (IRR) 3.94; p = 0.0058); this was confirmed in the reduced Cox proportional hazards model, HR 3.81 (95%CI: 1.12–12.91). Patients with IE were younger than those without IE (p = 0.017), and 77% of cases with IE received medical therapy whilst 23% received medical-surgical therapy. Among medically treated patients, 55% needed catheter re-intervention. The medical-surgical group experienced more severe symptoms, including increased pulmonary valve stenosis. Methicillin-resistant Staphylococcus aureus, Coxiella burnetii, and Streptococcus gordonii together accounted for 65% of cases. Medical therapy is effective for uncomplicated tPVR-endocarditis. The Melody valve has nearly fourfold higher endocarditis rate and increased mortality. Therefore, pre-implant assessment is recommended for younger high-risk patients.