The problem of infective endocarditis after transcatheter pulmonary valve implantation

The first ever transcatheter valve implantation was performed by Philip Bonhoeffer in 2000 when he implanted the first version of the Melody valve into a failing prosthetic conduit from the RV to the pulmonary artery.1 Since then transcatheter pulmonary valve implantation (TCPVI) has become an attractive and nowadays widely used alternative to surgical pulmonary valve replacement.2 While this procedure was initially designed for treatment of pulmonary conduit failure, its ‘off label’ applications have recently become more common. Smaller case series have been published reporting on strategies and techniques to implant a transcatheter valve into the ‘native’, compliant outflow tract or into failing tricuspid valve prostheses.3 ,4 The potential advantages of TCPVI over open-heart surgery are obvious (eg, shorter recovery time from the procedure and reduction of the number of cardiopulmonary bypass procedures per lifetime), but concerns remain about the longevity of the valve and above all about the risk of infective endocarditis (IE). van Dijck et al 5 report the incidence of IE after TCPVI using the Melody valve system in their institution. This on its own is an important addition to the existing literature, but the main value of this publication relates to the fact that these data are reported in comparison with surgical implantation of homograft and Contegra conduits. …