July 11, 2026Journal of the American College of Cardiology99 citations
View Full PaperMulticenter Study of Endocarditis After Transcatheter Pulmonary Valve Replacement
Key Result
Following transcatheter pulmonary valve replacement, the cumulative incidence of endocarditis was 9.5% at 5 years, with younger age, prior endocarditis, and higher residual gradient as risk factors.
Key Points
- To evaluate the incidence and outcomes of endocarditis following transcatheter pulmonary valve replacement across multiple centers.
- Multicenter design involving several hospitals
- Analysis of patient outcomes post-intervention
- Data collection of endocarditis occurrences
- The incidence of endocarditis was identified in a significant percentage of patients post-procedure.
- Specific risk factors related to endocarditis were documented and analyzed.
- Outcomes showed varying degrees of recovery and complications among affected individuals.
Study Design
Type
Cohort (n=2,476)
Multicenter
Yes
PICO
P
Population
2,476 patients who underwent transcatheter pulmonary valve replacement, followed for 8,475 patient-years to evaluate the incidence and risk factors of endocarditis.
E
Exposure / Comparator
Transcatheter pulmonary valve replacement
O
Primary Outcome
Endocarditis at 5 years (7.9-11.1)
Abstract
BACKGROUND Endocarditis has emerged as one of the most impactful adverse events after transcatheter pulmonary valve replacement (TPVR), but there is limited information about risk factors for and outcomes of this complication. OBJECTIVES The purpose of this study was to evaluate risk factors for and outcomes of endocarditis in a large multicenter cohort. METHODS The authors established an international registry focused on characterizing endocarditis after TPVR, including the incidence, risk factors, characteristics, and outcomes. RESULTS Investigators submitted data for 2,476 patients who underwent TPVR between July 2005 and March 2020 and were followed for 8,475 patient-years. In total, 182 patients were diagnosed with endocarditis a median of 2.7 years after TPVR, for a cumulative incidence of 9.5% (95% CI: 7.9%-11.1%) at 5 years and 16.9% (95% CI: 14.2%-19.8%) at 8 years (accounting for competing risks: death, heart transplant, and explant) and an annualized incidence of 2.2 per 100 patient-years. Staphylococcus aureus and Viridans group Streptococcus species together accounted for 56% of cases. Multivariable analysis confirmed that younger age, a previous history of endocarditis, and a higher residual gradient were risk factors for endocarditis, but transcatheter pulmonary valve type was not. Overall, right ventricular outflow tract (RVOT) reintervention was less often to treat endocarditis than for other reasons, but valve explant was more often caused by endocarditis. Endocarditis was severe in 44% of patients, and 12 patients (6.6%) died, nearly all of whom were infected with Staphylococcus aureus. CONCLUSIONS The incidence of endocarditis in this multicenter registry was constant over time and consistent with prior smaller studies. The findings of this study, along with ongoing efforts to understand and mitigate risk, will be critical to improve the lifetime management of patients with heart disease involving the RVOT. Although endocarditis can be a serious adverse outcome, TPVR remains an important tool in the management of RVOT dysfunction.