Key result
Transcatheter pulmonary valve replacement is associated with a higher risk of infective endocarditis compared to surgical pulmonary valve replacement, particularly when using Melody valves.
Why the study?
Infective endocarditis can complicate recovery and increase long-term mortality after pulmonary valve replacement, but differences in IE outcomes between surgical and transcatheter approaches required evaluation.
Does transcatheter pulmonary valve replacement increase the risk of infective endocarditis compared to surgical pulmonary valve replacement in patients with congenital heart disease?
Systematic Review
Does transcatheter pulmonary valve replacement increase the risk of infective endocarditis compared to surgical pulmonary valve replacement in patients with congenital heart disease?
While transcatheter pulmonary valve replacement is generally preferred for its minimally invasive nature, it is associated with a higher risk of infective endocarditis compared to surgical replacement, particularly when using the Melody valve.
May warrant surgical preference to minimize endocarditis risk in congenital patients; reinforces transcatheter signal in systematic synthesis.
Pulmonary valve replacement (PVR) is the most common cardiac operation in adult patients with congenital heart disease (ACHD). It can improve right ventricular outflow tract (RVOT) obstruction, typically due to pulmonary valve stenosis or regurgitation. PVR can be performed surgically (open-heart) and through a transcatheter (percutaneous) method, which is minimally invasive and is associated with shorter hospitalization stays. However, following PVR, infectious endocarditis (IE) can complicate the recovery process and increase mortality in the long term. IE is a rare but deadly multi-organ system condition caused by microorganisms traversing the bloodstream from a specific entry point. It can have many presentations, such as splinter hemorrhages, fevers, and vegetation on valves that lead to stroke consequences. This paper aims to evaluate the differences in the rate, etiology, manifestations, treatment, and outcomes of IE following surgical and transcatheter PVR, as the goal is to perform a procedure with few complications. In both approaches, Staphylococcus aureus was the most common microorganism that affected the valves, followed by Streptococcus viridians. Research has shown that surgical pulmonary valve replacement (SPVR) has a decreased risk of IE following surgery compared to TPVR. However, TPVR is preferred due to the reduced overall risk and complications of the procedure. Despite this, the consensus on mortality rates does differ. Future research should consider the type of valves used for transcatheter pulmonary valve replacement (TPVR), such as Melody valves versus Edward Sapien valves, as their IE rates vary significantly.
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Slouha et al. (2023) conducted a systematic review in Congenital heart disease requiring pulmonary valve replacement. Transcatheter pulmonary valve replacement (TPVR) vs. Surgical pulmonary valve replacement (SPVR) was evaluated on Incidence of infective endocarditis. Transcatheter pulmonary valve replacement is associated with a higher risk of infective endocarditis compared to surgical pulmonary valve replacement, particularly when using Melody valves.
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