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Original article
Infective endocarditis of a transcatheter pulmonary valve in comparison with surgical implants
  1. Ine Van Dijck1,
  2. Werner Budts2,
  3. Bjorn Cools1,
  4. Benedicte Eyskens1,
  5. Derize E Boshoff1,
  6. Ruth Heying1,
  7. Stefan Frerich3,
  8. Ward Y Vanagt3,
  9. Els Troost2,
  10. Marc Gewillig1
  1. 1Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium
  2. 2Department of Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium
  3. 3Department of Pediatric Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands
  1. Correspondence to Professor Marc Gewillig, University Hospital Gasthuisberg, Herestraat 49, Leuven B-3000, Belgium; marc.gewillig{at}uzleuven.be

Abstract

Background Melody valved stents (Medtronic Inc, Minneapolis, Minnesota, USA) have become a very competitive therapeutic option for pulmonary valve replacement in patients with congenital heart disease. After adequate prestenting of the right ventricular outflow tract (RVOT) Melody valved stents have a good medium term functional result but are exposed to infective endocarditis (IE).

Patients and methods Retrospective study of tertiary centre Congenital Heart Disease database; to compare incidence of IE in three different types of valved conduits in RVOT: Melody valved stent, cryopreserved homograft (European Homograft Bank) and Contegra graft (Medtronic Inc).

Results Between 1989 and 2013, 738 conduits were implanted in 677 patients. 107 Melody valved stents were implanted in 107 patients; IE occurred in 8 (7.5%) patients during a follow-up of 2.0 years (IQR 2.4 years, range 0.3–7.8 years). 577 Homografts were implanted in 517 patients; IE occurred in 14 patients (2.4%) during a median follow-up of 6.5 years (IQR 9.2 years; range 0.1–23.7 years). Finally, 54 Contegra grafts were implanted in 53 patients; 11 patients (20.4%) had IE during a follow-up of 8.8 years (IQR 7.7 years; range 0.2–3.5 years). Survival free of IE by Kaplan–Meier for homografts was 98.7% at 5 years and 97.3% at 10 years; for Contegra 87.8% at 5 years and 77.3% at 10 years and for Melody 84.9% at 5 years (log-rank test; p<0.001).

Conclusions The Contegra conduit and Melody valved stents have a significantly higher incidence of IE than homografts. IE is a significant threat for long-term conduit function.

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