Impact of a structured patient education programme on early diagnosis of prosthetic pulmonary valve endocarditis

2021 ◽  
pp. 1-6
Author(s):  
Daniela Babic ◽  
Ramona Hämmerli ◽  
Bruno Santos Lopes ◽  
Christine Attenhofer Jost ◽  
Daniel Tobler ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Patient Education ◽  
Early Diagnosis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Education Programme ◽  
Pulmonary Valve Replacement ◽  
High Dose ◽  
Valve Function ◽  
Patient Education Programme

Abstract Background: Infective endocarditis is a major threat after prosthetic pulmonary valve replacement. Early diagnosis may improve outcomes. Methods: A structured patient education programme for prevention and early diagnosis of infective endocarditis was developed at our institution since 2016. Time delay between onset of symptoms of prosthetic pulmonary valve endocarditis and its diagnosis (defined as initiation of appropriate high-dose intravenous antibiotic treatment) was compared for patients presenting before (cohort 1) and after (cohort 2) initiation of the patient education programme. Results: Between 2008–2019, 26 patients (median age 24.9, range: 16.8–62.0 years, 73% male) were diagnosed with prosthetic pulmonary valve endocarditis, 13 patients (cohort 1) before (1.7 cases/year) and 13 patients (cohort 2) after June 2016 (3.7 cases/year). There were no differences in baseline characteristics or clinical presentation between the study cohorts. Overall, the median delay between onset of symptoms and diagnosis of infective endocarditis was 6 days (range: 0–133 days) with a significantly longer delay among patients in cohort 1, compared to cohort 2 (25 days, range: 5–133 days versus 3 days, range: 0–13 days, p < 0.0001). A delay of >7 days was documented in 11/13 patients (85%) in cohort 1 as compared to 1/13 (8%) in cohort 2 (p < 0.001). Need for urgent valve replacement or permanent deterioration of prosthetic valve function was higher in cohort 1, compared to cohort 2 (11/13, 85% versus 5/13, 39%; p = 0.041). Conclusions: Prosthetic pulmonary valve endocarditis is increasingly recognised. A structured patient education programme may improve early diagnosis and clinical outcomes.

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 Pulmonary valve replacement with annulus enlargement for pulmonary valve infective endocarditis: A case report

2021 ◽  
Vol 9 (6) ◽  
Author(s):  
Kei Aizawa ◽  
Ryohei Horikoshi ◽  
Keisuke Shimizu ◽  
Satoshi Uesugi ◽  
Akira Sugaya ◽  
...  
Keyword(s):  
Case Report ◽  
Infective Endocarditis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement

Incidence and outcome of infective endocarditis following percutaneous versus surgical pulmonary valve replacement

2017 ◽  
Vol 91 (2) ◽  
pp. 277-284 ◽  
Author(s):  
Gentian Lluri ◽  
Daniel S. Levi ◽  
Emily Miller ◽  
Abbie Hageman ◽  
Sanjay Sinha ◽  
...  
Keyword(s):  
Infective Endocarditis ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement

Abstract 16466: Greater Body Mass Index Predicts Valve Function Following Transcatheter Pulmonary Valve Replacement in Adults With Tetralogy of Fallot

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Zachary Daniels ◽  
Anudeep Dodeja ◽  
Victoria Shay ◽  
Yubo Tan ◽  
Shasha Bai ◽  
...  
Keyword(s):  
Body Mass Index ◽  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Body Mass ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Significant Difference ◽  
Valve Function ◽  
The Impact

Introduction: After the initial surgical repair of tetralogy of Fallot (rTOF), right ventricular outflow tract dysfunction is common, with pulmonary stenosis (PS), regurgitation, or both. Obese adults with rTOF have worse biventricular systolic function, and greater post-operative pulmonary valve replacement morbidity than non-obese patients. Transcatheter PVR (TPVR) is used increasingly, though no studies have examined the impact of body mass index (BMI) on morbidity and hemodynamics in adults with rTOF and subsequent TPVR. Hypothesis: BMI affects outcomes of transcatheter PVR in adults with TOF. Methods: This was a 10 yr, single center, retrospective review of adults (>18 yo) with rTOF who underwent TPVR. The cohort was split into 2 groups based on BMI at time of TPVR. Group A (Grp A): normal and overweight (BMI <30), group B (Grp B): obese (BMI ≥30). Pre and post-TPVR echocardiogram, cardiac MRI, and catheterization data were reviewed. Results: There were 81 adults, 42 (52%) normal, 18 (22%) overweight (Grp A) and 21 (26%) obese (Grp B). Mean follow up was 6.4 + 3.1 yrs. With most recent post-TPVR echocardiogram, there was no significant difference in LV or RV size and function across groups. Compared to Grp A, Grp B patients were more likely to develop any degree of PS (mild, moderate, or severe) following TPVR (69% vs 94%, respectively, p = 0.032). An ROC curve analysis demonstrated BMI ≥ 26.3 had a low sensitivity (45%), but good specificity (89%) for predicting PS post TPVR. There was no difference between groups requiring re- intervention for PVR. Conclusion: This is the first study to show greater BMI affects valve function in adults with rTOF following TPVR. BMI >26 was associated with a greater risk of PS in follow up echocardiograms after TPVR. Obesity is an epidemic in the US and patient prosthesis mismatch may be an issue when considering TPVR. Further studies are indicated to determine the long-term effects of BMI on TPVR and the need for re-intervention in adults with TOF.

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