Prosthetic pulmonary valve infectious endocarditis in paediatric congenital heart disease patients

OBJECTIVES: Pulmonary valve implantation (PVI) is common in children with congenital heart disease particularly as they get older. While surgical PVI (SPVI) was the mainstay of treatment for years, percutaneous PVI (PPVI) has evolved into a popular treatment option. The aim of our study was to evaluate the rate of prosthetic pulmonary valve infectious endocarditis (PPVIE) between these two modes of intervention. METHODS: Retrospective, single-centre review of paediatric patients at a tertiary referral centre from 1993 to 2022 who underwent PVI. Method of intervention (SPVI vs PPVI) and type of pulmonary valve (PV) prosthesis were used as comparison groups. Occurrence of and time interval to the onset of PPVIE were the primary outcomes of interest. RESULTS: There were 467 patients who underwent 686 PVIs (665 SPVI [96.9%] and 21 PPVI [3.1%]). The surgical prostheses were all biologic valved conduits: aortic homograft (118, 17.7%), pulmonary homograft (312, 46.9%) and Contegra (235, 35.3%). The percutaneous prostheses were exclusively Melody valves (21, 100.0%). Incidence of PPVIE was 5.1% (35/689) for all PVIs. Annualized incidence of PPVIE was 0.37% for all PVs; and 0.09% for aortic homografts, 0.14% for pulmonary homografts, 1.05% for Contegra conduits and 2.93% for Melody valves. Freedom from PPVIE (FPI) was 92.1% at 30.9 years after intervention for all PVIs. Bovine jugular vein (BJV) valves (Contegra and Melody) had an increased risk of PPVIE compared with surgically implanted homograft valves. Method of PVI (PPVI vs SPVI) was less important than the material of which the implanted PV prosthesis was constructed (homograft vs BJV graft). CONCLUSIONS: BJV PV prostheses were more prone to infection than homografts, irrespective of method of implantation. Melody valves, though smaller in number of PVIs performed, displayed a trend toward increased rate of PPVIE.