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

2021 ◽  
Author(s):  
Arpine Davtyan ◽  
Peter W. Guyon ◽  
Hannah R. El-Sabrout ◽  
Reid Ponder ◽  
Nanda Ramchandar ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Retrospective Analysis ◽  
Antimicrobial Therapy ◽  
Pulmonary Valve ◽  
Factors Associated ◽  
Cart Analysis ◽  
Melody Valve ◽  
Practice Variations

AbstractGuidelines 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.

Infective endocarditis following Melody valve implantation: comparison with a surgical cohort

2016 ◽  
Vol 27 (2) ◽  
pp. 294-301 ◽  
Author(s):  
Clare O’Donnell ◽  
Rhonda Holloway ◽  
Elizabeth Tilton ◽  
John Stirling ◽  
Kirsten Finucane ◽  
...  
Keyword(s):  
Risk Factors ◽  
New Zealand ◽  
Infective Endocarditis ◽  
Pulmonary Valve ◽  
Good Alternative ◽  
Melody Valve ◽  
Life Threatening ◽  
Valve Implantation ◽  
Percutaneous Pulmonary Valve

AbstractBackgroundInfective endocarditis has been reported post Melody percutaneous pulmonary valve implant; the incidence and risk factors, however, remain poorly defined. We identified four cases of endocarditis from our first 25 Melody implants. Our aim was to examine these cases in the context of postulated risk factors and directly compare endocarditis rates with local surgical valves.MethodsWe conducted a retrospective review of patients post Melody percutaneous pulmonary valve implant in New Zealand (October, 2009–May, 2015) and also reviewed the incidence of endocarditis in New Zealand among patients who have undergone surgical pulmonary valve implants.ResultsIn total, 25 patients underwent Melody implantation at a median age of 18 years. At a median follow-up of 2.9 years, most were well with low valve gradient (median 27 mmHg) and only mild regurgitation. Two patients presented with life-threatening endocarditis and obstructive vegetations at 14 and 26 months post implant, respectively. Two additional patients presented with subacute endocarditis at 5.5 years post implant. From 2009 to May, 2015, 178 surgical pulmonic bioprostheses, largely Hancock valves and homografts, were used at our institution. At a median follow-up of 2.9 years, four patients (2%) had developed endocarditis in this group compared with 4/25 (16%) in the Melody group (p=0.0089). Three surgical valves have been replaced.ConclusionsThe Melody valve offers a good alternative to surgical conduit replacement in selected patients. Many patients have excellent outcomes in the medium term. Endocarditis, however, can occur and if associated with obstruction can be life threatening. The risk for endocarditis in the Melody group was higher in comparison with that in a contemporaneous surgical pulmonary implant cohort.

scholarly journals Risk of infective endocarditis among patients with tetralogy of fallot

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
E Havers-Borgersen ◽  
J.H Butt ◽  
M Groening ◽  
M Smerup ◽  
G.H Gislason ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Cox Regression ◽  
Pulmonary Valve Replacement ◽  
Varying Coefficients ◽  
Background Population ◽  
Increased Risk

Abstract Introduction Patients with tetralogy of Fallot (ToF) are considered at high risk of infective endocarditis (IE) as a result of altered hemodynamics and multiple surgical and interventional procedures including pulmonary valve replacement (PVR). The overall survival of patients with ToF has increased in recent years. However, data on the risk of adverse outcomes including IE are sparse. Purpose To investigate the risk of IE in patients with ToF compared with controls from the background population. Methods In this nationwide observational cohort study, all patients with ToF born in 1977–2017 were identified using Danish nationwide registries and followed from date of birth until occurrence of an outcome of interest (i.e. first-time IE), death, or end of study (July 31, 2017). The comparative risk of IE among ToF patients versus age- and sex-matched controls from the background population was assessed. Results A total of 1,156 patients with ToF were identified and matched with 4,624 controls from the background population. Among patients with ToF, 266 (23.0%) underwent PVR during follow-up. During a median follow-up time of 20.4 years, 38 (3.3%) patients and 1 (0.03%) control were admitted with IE. The median time from date of birth to IE was 10.8 years (25th-75th percentile 2.8–20.9 years). The incidence rates of IE per 1,000 person-years were 2.2 (95% confidence interval (CI) 1.6–3.0) and 0.01 (95% CI 0.0001–0.1) among patients and controls, respectively. In multivariable Cox regression models, in which age, sex, pulmonary valve replacement, and relevant comorbidities (i.e. chronic renal failure, diabetes mellitus, presence of cardiac implantable electronic devices, other valve surgeries), were included as time-varying coefficients, the risk of IE was significantly higher among patients compared with controls (HR 171.5, 95% CI 23.2–1266.7). Moreover, PVR was associated with an increased risk of IE (HR 3.4, 95% CI 1.4–8.2). Conclusions Patients with ToF have a substantial risk of IE and the risk is significantly higher compared with the background population. In particular, PVR was associated with an increased risk of IE. With an increasing life-expectancy of these patients, intensified awareness, preventive measures, and surveillance of this patient group are advisable. Figure 1. Cumulative incidence of IE Funding Acknowledgement Type of funding source: None

scholarly journals Infective Endocarditis After Transcatheter Pulmonary Valve Replacement Using the Melody Valve

2013 ◽  
Vol 6 (3) ◽  
pp. 292-300 ◽  
Author(s):  
Doff B. McElhinney ◽  
Lee N. Benson ◽  
Andreas Eicken ◽  
Jacqueline Kreutzer ◽  
Robert F. Padera ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Melody Valve ◽  
Transcatheter Pulmonary Valve Replacement

scholarly journals Surgical Treatment of Infective Endocarditis in Pulmonary Position—15 Years Single Centre Experience

Medicina ◽  
2019 ◽  
Vol 55 (9) ◽  
pp. 608 ◽  
Author(s):  
Liekiene ◽  
Bezuska ◽  
Semeniene ◽  
Cypiene ◽  
Lebetkevicius ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Congenital Heart ◽  
Pulmonary Valve ◽  
Late Results ◽  
Term Survival ◽  
Single Centre Experience ◽  
Heart Malformation ◽  
Long Term Follow Up

Background and Objectives: Infective endocarditis in the pulmonary position is a rare disease. Isolated pulmonary valve endocarditis is extremely rare. The aim of our study was to assess patients who were treated surgically for pulmonary endocarditis at our institution from January 2003 to December 2017. Materials and Methods: We analyze eight cases of infectious endocarditis in pulmonary position out of 293 patients who were operated for infective endocarditis (2.7%, 8/293). Only two of these eight patients were not related to congenital heart malformation. They were followed for early and late mortality, long-term survival, postoperative morbidity and reoperations. Results: Among six patients suffering from congenital heart disease, four patients underwent corrections of pulmonary valve malformation previously, and their infected grafts were replaced by two allografts and two xenografts. The two other patients had replaced their infected pulmonary valves with allografts. Two non-congenital patients with pulmonary valve endocarditis underwent valve replacement with biological prosthesis. All patients survived the early postoperative course. The mean follow-up time was 9.1 (interquartile range (IQR), 5.3–12.6) years. The long-term follow-up included seven patients. One patient (12.5%, 1/8) died more than 4 years after the surgery due to sepsis. Pulmonary endocarditis was the rarest endocarditis treated surgically (p < 0.001). Conclusion: Surgery for infective endocarditis in the pulmonary position (IEPP) is an effective method of treatment with excellent early outcome and good late results despite a very uncommon pathology and few operations being performed. Surgery performed earlier may make the procedure less radical.

Brainstem arteriovenous malformations: lesion characteristics and treatment outcomes

2018 ◽  
Vol 128 (1) ◽  
pp. 126-136
Author(s):  
Venkatesh S. Madhugiri ◽  
Mario K. C. Teo ◽  
Joli Vavao ◽  
Teresa Bell-Stephens ◽  
Gary K. Steinberg
Keyword(s):  
Functional Outcome ◽  
Treatment Outcomes ◽  
Retrospective Analysis ◽  
Arteriovenous Malformations ◽  
Neurological Status ◽  
Morbidity Rate ◽  
Factors Associated ◽  
Cure Rates ◽  
Complex Lesions

OBJECTIVEBrainstem arteriovenous malformations (AVMs) are rare lesions that are difficult to diagnose and treat. They are often more aggressive in their behavior when compared with their supratentorial counterparts. The consequence of a brainstem hemorrhage is often devastating, and many patients are in poor neurological status at presentation. The authors examine the factors associated with angiographically confirmed cure and those affecting management outcomes for these complex lesions.METHODSThis was a retrospective analysis of data gathered from the prospectively maintained Stanford AVM database. Lesions were grouped based on their location in the brainstem (medulla, pons, or midbrain) and the quadrant they occupied. Angiographic cure was dichotomized as completely obliterated or not, and functional outcome was dichotomized as either independent or not independent at last follow-up.RESULTSOver a 23-year period, 39 lesions were treated. Of these, 3 were located in the medulla, 14 in the pons, and 22 in the midbrain. At presentation, 92% of the patients had hemorrhage, and only 43.6% were functionally independent. Surgery resulted in the best radiographic cure rates, with a morbidity rate of 12.5%. In all, 53% of patients either improved or remained stable after surgery. Absence of residual nidus and female sex correlated with better outcomes.CONCLUSIONSBrainstem AVMs usually present with hemorrhage. Surgery offers the best chance of cure, either in isolation or in combination with other modalities as appropriate.

COVID-19 infection with delayed presentation of infective endocarditis of the prosthetic pulmonary valve

2021 ◽  
pp. 1-3
Author(s):  
Romila Chimoriya ◽  
Neeraj Awasthy ◽  
Gaurav Kumar
Keyword(s):  
Infective Endocarditis ◽  
Pulmonary Valve ◽  
Right Ventricular Outflow Tract ◽  
Ventricular Outflow Tract ◽  
Delayed Presentation ◽  
Limited Evidence ◽  
Cardiovascular Comorbidity ◽  
Melody Valve ◽  
Valve Implantation ◽  
Pulmonary Valve Implantation

Abstract Pulmonary valve endocarditis after transcatheter pulmonary valve implantation has been an emerging concern due to the increasing prevalence of transcatheter placement of pulmonary valve in the treatment of residual right ventricular outflow tract stenosis or regurgitation. Pulmonary valve endocarditis is a dreadful complication of transcatheter pulmonary valve implantation that have been reported with Melody valve (Medtronic, Inc., Minneapolis, MN) and Edward Sapien valve (Edwards Life Sciences, Irvine, CA) till date. There are scanty available literatures for pulmonary valve endocarditis with Venus P valve (Venus Medtech, Hangzhou, China) implantation. Furthermore, cardiovascular comorbidity is common in COVID-19 infection with limited evidence of COVID-19 infection concomitant with infective endocarditis. This case happens to be the first reported case of infective endocarditis of pulmonary valve with concomitant COVID-19 infection and also delayed presentation of pulmonary valve endocarditis with Venus P valve implantation.

scholarly journals Long-term outcomes of pulmonary valve replacement in patients with repaired tetralogy of Fallot

2020 ◽  
Vol 58 (2) ◽  
pp. 246-252
Author(s):  
Cheul Lee ◽  
Eun Seok Choi ◽  
Chang-Ha Lee
Keyword(s):  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Left Ventricular ◽  
Volume Index ◽  
Long Term Outcomes ◽  
Systolic Volume ◽  
Factors Associated ◽  
End Systolic Volume

Abstract OBJECTIVES The objectives of this study were to evaluate long-term outcomes of pulmonary valve replacement (PVR) in patients with repaired tetralogy of Fallot (TOF) and to identify the factors associated with adverse clinical events (ACEs). METHODS A total of 190 patients who underwent PVR between 1998 and 2015 after repair of TOF were retrospectively analysed. ACE was defined as all-cause death, heart transplantation or new-onset sustained arrhythmia. Univariable Cox proportional hazards regression analysis was used to identify the factors associated with ACE after PVR. RESULTS The median age at PVR was 19 years. Preoperative magnetic resonance imaging (MRI) was performed in 143 (75%) patients, and the median right ventricular (RV) end-diastolic and end-systolic volume index was 164 and 82 ml/m2, respectively. The follow-up completeness was 94%, and the median follow-up duration was 9.8 years. The transplantation-free survival and freedom from ACE at 15 years was 95% and 90%, respectively. The factors associated with ACE were older age at PVR, older age at TOF repair, New York Heart Association functional class III or IV, presence of tachyarrhythmias, longer cardiopulmonary bypass time and concomitant arrhythmia surgery. In a subgroup analysis of 143 patients with preoperative MRI data, larger RV end-systolic volume index, larger left ventricular end-systolic volume index and lower left ventricular ejection fraction were associated with ACE. CONCLUSIONS Long-term outcomes of PVR in patients with repaired TOF were satisfactory. Proactive PVR before the onset of advanced symptoms, tachyarrhythmias and ventricular dysfunction may further improve the long-term survival of this patient population.

scholarly journals Combined Transcatheter Tricuspid and Pulmonary Valve Replacement

2020 ◽  
Vol 11 (4) ◽  
pp. 432-437
Author(s):  
Adam J. Small ◽  
Olcay Aksoy ◽  
Daniel S. Levi ◽  
Morris M. Salem ◽  
Eric H. Yang ◽  
...  
Keyword(s):  
Congenital Heart Disease ◽  
Heart Disease ◽  
Valve Replacement ◽  
Congenital Heart ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Tricuspid Valve Replacement ◽  
Melody Valve ◽  
Valve Implantation

Background: For patients with combined tricuspid and pulmonary valve disease, operative intervention carries high mortality risk. Published reports of combined transcatheter tricuspid and pulmonary valve replacement have been limited to single cases. Methods: A retrospective chart review was performed including all patients undergoing combined transcatheter tricuspid and pulmonary valve replacement at the Ahmanson/UCLA Adult Congenital Heart Disease Center. Results: Combined transcatheter tricuspid and pulmonary valve replacement was undertaken in five adult patients (median age: 46 years; range: 24-64 years). Three had congenital heart disease and two had carcinoid syndrome. Four patients had previous surgical tricuspid valve replacement and one had a surgical incomplete annuloplasty ring. Four patients had previous surgical pulmonary valve replacement and one had a right ventricle-to-pulmonary artery homograft conduit. Two patients underwent Medtronic Melody valve implantation in both tricuspid and pulmonary positions and three underwent Edwards Sapien S3 implantation in both tricuspid and pulmonary positions. Valve implantation was successful in all. Follow-up ranged from 0.9 to 3.0 years. One patient underwent redo transcatheter tricuspid valve replacement 12 months after the first transcatheter intervention for progressive regurgitation of a Melody valve. This patient died 2.5 years after combined valve placement of complications from refractory heart failure. The remaining patients were alive and free of valve reintervention at follow-up. Conclusions: Combined transcatheter tricuspid and pulmonary valve replacement can be performed successfully, with an acceptable complication rate. This strategy is a feasible option for appropriately selected patients.

Usefulness of intracardiac echocardiography for the diagnosis of infective endocarditis following percutaneous pulmonary valve replacement

2017 ◽  
Vol 27 (7) ◽  
pp. 1406-1409 ◽  
Author(s):  
Sara Bouajila ◽  
Aurélie Chalard ◽  
Claire Dauphin
Keyword(s):  
Infective Endocarditis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Transoesophageal Echocardiography ◽  
Intracardiac Echocardiography ◽  
Pulmonary Valve Replacement ◽  
Melody Valve ◽  
Percutaneous Pulmonary Valve

AbstractInfective endocarditis is a serious complication occurring after percutaneous pulmonary valve replacement with a Melody valve; it is of uncertain incidence, and presents a challenging diagnosis. Vegetations may be difficult to visualise with transthoracic and transoesophageal echocardiography. We report the role of intracardiac echocardiography in this condition by confirming the prosthesis involvement.

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