Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience

Pediatr Cardiol. 2022 Apr;43(4):894-902. doi: 10.1007/s00246-021-02801-z. Epub 2021 Dec 11.

Abstract

Guidelines for management of Melody transcatheter pulmonary valve (TPV) infective endocarditis (IE) are lacking. We aimed to identify factors associated with surgical valve removal versus antimicrobial therapy in Melody TPV IE. Multicenter retrospective analysis of all patients receiving Melody TPV from 10/2010 to 3/2019 was performed to identify cases of IE. Surgical explants versus non-surgical cases were compared. Of the 663 Melody TPV implants, there were 66 cases of IE in 59 patients (59/663, 8.8%). 39/66 (59%) were treated with IV antimicrobials and 27/66(41%) underwent valve explantation. 26/59 patients (44%) were treated medically without explantation or recurrence with average follow-up time of 3.5 years (range:1-9). 32% of Streptococcus cases, 53% of MSSA, and all MRSA cases were explanted. 2 of the 4 deaths had MSSA. CART analysis demonstrated two important parameters associated with explantation: a peak echo gradient ≥ 47 mmHg at IE diagnosis(OR 10.6, p < 0.001) and a peak echo gradient increase of > 24 mmHg compared to baseline (OR 6.7, p = 0.01). Rates of explantation varied by institution (27 to 64%). In our multicenter experience, 44% of patients with Melody IE were successfully medically treated without valve explantation or recurrence. The degree of valve stenosis at time of IE diagnosis was strongly associated with explantation. Rates of explantation varied significantly among the institutions.

Keywords: Congenital heart disease; Endocarditis; Melody valve; Transcatheter pulmonary valve.

Publication types

  • Multicenter Study

MeSH terms

  • Cardiac Catheterization / adverse effects
  • Endocarditis* / etiology
  • Endocarditis* / surgery
  • Endocarditis, Bacterial* / drug therapy
  • Endocarditis, Bacterial* / surgery
  • Heart Valve Prosthesis Implantation* / adverse effects
  • Heart Valve Prosthesis* / adverse effects
  • Humans
  • Prosthesis Design
  • Pulmonary Valve Insufficiency* / surgery
  • Pulmonary Valve* / surgery
  • Retrospective Studies
  • Treatment Outcome