Key result
Initial medical therapy for post-TPVR infective endocarditis carries ~33% relapse risk, favoring surgical intervention.
Why the study?
Recipients of TPVR show an increased risk of IE, but little is known about the outcomes of different management strategies, particularly surgery.
Does surgical therapy improve outcomes compared to medical therapy only in patients with infective endocarditis following transcatheter pulmonary valve replacement?
Observational (n=69)
Yes
Does surgical therapy improve outcomes compared to medical therapy only in patients with infective endocarditis following transcatheter pulmonary valve replacement?
Initial medical therapy for IE after TPVR may result in high rates of relapse and readmission, suggesting surgical therapy may be more effective despite higher associated mortality.
Initial medical therapy for post-TPVR IE may incur high relapse; leaves open whether surgery improves net outcomes.
BACKGROUND: Recipients of transcatheter pulmonary valve replacement (TPVR) have shown increased risk of infective endocarditis (IE). Little is known about the outcomes of different management strategies, particularly surgery, for IE after TPVR. METHODS: We queried the Pediatric Health Information System database for cases of IE after TPVR performed from 2010-2020. We described patient demographics, hospital courses, admission complications, and treatment outcomes based on therapy offered, surgical or medical only. We compared outcomes of initial therapy. Data are expressed as median or percent. RESULTS: Sixty-nine cases of IE were identified, accounting for 98 related hospital admissions; 29% of patients recorded IE-related readmissions. Of those readmitted after initial medical therapy only, 33% had relapse IE. Rates of surgery were 22% during initial admission and 36% overall. Likelihood of surgical intervention increased with each subsequent admission. Renal and respiratory failure were more common in those given initial surgery. Mortality rate was 4.3% overall and 8% in the surgical cohort. CONCLUSION: Initial medical therapy may result in relapses/readmissions and possible delay of surgical therapy, which appears to be most effective for treatment of IE. For those treated only medically, a more aggressive course of therapy may be more likely to prevent relapse. Mortality following surgical therapy for IE after TPVR appears higher than reported for surgical pulmonary valve replacement generally.
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Fox et al. (2023) conducted an observational in Infective endocarditis following transcatheter pulmonary valve replacement (n=69). Surgical therapy vs. Medical therapy only was evaluated on Treatment outcomes including readmission, relapse, and mortality. Surgical therapy for infective endocarditis after TPVR had an 8% mortality rate, while initial medical therapy was associated with a 33% relapse rate among readmitted patients.
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