Management of prosthetic pulmonary valve endocarditis should include the selective application of transcatheter pulmonary valve replacement

Objective: Prosthetic pulmonary valve endocarditis (PPVE) limits survival and quality of life in patients with repaired congenital heart disease. We describe patient outcomes with PPVE in a single center and the application of transcatheter pulmonary valve replacement (TPVR). Methods: We performed a single-center retrospective review of patients with PPVE from 2010 to 2022. Subjects were stratified by initial treatment: group 1 comprised surgical pulmonary valve replacement (SPVR), group 2 comprised TPVR, and group 3 comprised initial medical therapy without plans for upfront surgical or procedural intervention. Micro-organism data, posttreatment morbidity, length of stay, recurrence, and mortality are reported. Results: Seventy patients met inclusion criteria; 7% (group 2) underwent TPVR, and 80% of these patients underwent TPVR as a bridge to SPVR. No patients from group 2 had recurrence. Mortality was similar in the upfront SPVR and TPVR groups (group 1: 17.4%, group 2: 20%, group 3: 2.4%). In total, 71% of patients in group 3 eventually required elective SPVR or TPVR, with 25% of patients undergoing TPVR after clearance of blood cultures having recurrence compared with 7.1% of patients who underwent SPVR after clearance of blood cultures. Conclusions: TPVR is a viable bridge to SPVR in select patients with PPVE and may serve as destination therapy. Recurrence may be more common in patients requiring PVR after clearance of infection. Prospective studies of first-line TPVR as a strategy for bridge-to-surgery in select high risk patients and destination therapy in patients with resolution of bacteremia are needed to define treatment pathways.