December 24, 2014Heart190 citations
View Full PaperInfective endocarditis of a transcatheter pulmonary valve in comparison with surgical implants
Key Result
Melody valved stents and Contegra grafts had significantly lower 5-year survival free of infective endocarditis (84.9% and 87.8%, respectively) compared to homografts (98.7%; P<0.001).
Study Design
Type
Cohort (n=677)
Multicenter
No
Structured PICO
Does the type of RVOT conduit (Melody, Contegra, or homograft) affect the incidence of infective endocarditis in patients with congenital heart disease?
P
Population
677 patients with congenital heart disease who received 738 valved conduits in the right ventricular outflow tract, evaluated retrospectively for infective endocarditis.
E
Exposure
Melody valved stent (n=107 patients) or Contegra graft (n=53 patients)
C
Comparator
Cryopreserved homograft (n=517 patients)
O
Outcome
Incidence of infective endocarditis (IE)hard clinical
Contegra and Melody valved stents are associated with a significantly higher incidence of infective endocarditis compared to cryopreserved homografts in patients with congenital heart disease.
Main Result
Absolute Event Rate: 84.9% vs 98.7%
p-value: p=<0.001
Abstract
BACKGROUND: Melody valved stents (Medtronic Inc, Minneapolis, Minnesota, USA) have become a very competitive therapeutic option for pulmonary valve replacement in patients with congenital heart disease. After adequate prestenting of the right ventricular outflow tract (RVOT) Melody valved stents have a good medium term functional result but are exposed to infective endocarditis (IE). PATIENTS AND METHODS: Retrospective study of tertiary centre Congenital Heart Disease database; to compare incidence of IE in three different types of valved conduits in RVOT: Melody valved stent, cryopreserved homograft (European Homograft Bank) and Contegra graft (Medtronic Inc). RESULTS: Between 1989 and 2013, 738 conduits were implanted in 677 patients. 107 Melody valved stents were implanted in 107 patients; IE occurred in 8 (7.5%) patients during a follow-up of 2.0 years (IQR 2.4 years, range 0.3-7.8 years). 577 Homografts were implanted in 517 patients; IE occurred in 14 patients (2.4%) during a median follow-up of 6.5 years (IQR 9.2 years; range 0.1-23.7 years). Finally, 54 Contegra grafts were implanted in 53 patients; 11 patients (20.4%) had IE during a follow-up of 8.8 years (IQR 7.7 years; range 0.2-3.5 years). Survival free of IE by Kaplan-Meier for homografts was 98.7% at 5 years and 97.3% at 10 years; for Contegra 87.8% at 5 years and 77.3% at 10 years and for Melody 84.9% at 5 years (log-rank test; p<0.001). CONCLUSIONS: The Contegra conduit and Melody valved stents have a significantly higher incidence of IE than homografts. IE is a significant threat for long-term conduit function.