Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis

Although transcatheter pulmonary valve replacement (TPVR) with Melody and Sapien valves has been shown to be safe and effective, infective endocarditis (IE) of the valve remains a significant risk. The goal of this study is to assess how different immunocompromised states influence the likelihood of developing IE in our congenital heart disease population with these valves. A chart review was conducted of all patient who underwent TPVR at UCLA. Various risk factors including age, transcatheter valve type, and type of immunocompromised state were analyzed as possible risk factors for IE. CART analysis was used to create a visual representation of the interplay of various risk factors. The incidence of IE at our institution was approximately 8% (26 events in 339 valve implants), over a median follow up of 2.92 (0.07–9.71) years. All but one event occurred in patients with Melody valves. Patients with any immunocompromised condition were more likely to develop IE (P = 0.01). Presentation severity and outcome of IE was similar for immunocompromised and non-immunocompromised patients. Patients with DiGeorge syndrome and those taking oral immunosuppressants for autoimmune conditions or asthma were at highest risk for developing IE. The relatively high rate of endocarditis in TPVR patients, particularly in those with Melody valves, is a concerning development. A subset of immunocompromised patients appears to be at higher risk, and it may be beneficial for providers to be especially vigilant with these patients. Further research is needed to assess long-term risk of IE in all TPVR patients.