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Author Notes:

Arpine Davtyan, Email: adavtyan@health.ucsd.edu

All authors contributed to the study conception and design. Material preparation, data collection, and analysis were performed by AD, PG, RP, and HE-S. The first draft of the manuscript was written by AD and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.

The authors would like to thank Linda Drake, RN for her help with data collection and Euyhyun Lee for statistical analysis.

The authors have no conflict of interest to disclose.

Subject:

Keywords:

  • Endocarditis
  • Congenital heart disease
  • Transcatheter pulmonary valve
  • Melody valve

Selective Valve Removal for Melody Valve Endocarditis: Practice Variations in a Multicenter Experience

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Journal Title:

PEDIATRIC CARDIOLOGY

Volume:

Volume 43, Number 4

Publisher:

, Pages 894-902

Type of Work:

Article | Final Publisher PDF

Abstract:

Guidelines for management of Melody transcatheter pulmonary valve (TPV) infective endocarditis (IE) are lacking. We aimed to identify factors associated with surgical valve removal versus antimicrobial therapy in Melody TPV IE. Multicenter retrospective analysis of all patients receiving Melody TPV from 10/2010 to 3/2019 was performed to identify cases of IE. Surgical explants versus non-surgical cases were compared. Of the 663 Melody TPV implants, there were 66 cases of IE in 59 patients (59/663, 8.8%). 39/66 (59%) were treated with IV antimicrobials and 27/66(41%) underwent valve explantation. 26/59 patients (44%) were treated medically without explantation or recurrence with average follow-up time of 3.5 years (range:1–9). 32% of Streptococcus cases, 53% of MSSA, and all MRSA cases were explanted. 2 of the 4 deaths had MSSA. CART analysis demonstrated two important parameters associated with explantation: a peak echo gradient ≥ 47 mmHg at IE diagnosis(OR 10.6, p < 0.001) and a peak echo gradient increase of > 24 mmHg compared to baseline (OR 6.7, p = 0.01). Rates of explantation varied by institution (27 to 64%). In our multicenter experience, 44% of patients with Melody IE were successfully medically treated without valve explantation or recurrence. The degree of valve stenosis at time of IE diagnosis was strongly associated with explantation. Rates of explantation varied significantly among the institutions.

Copyright information:

© The Author(s) 2021

This is an Open Access work distributed under the terms of the Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/rdf).
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