1
|
Valdeolmillos E, Le Pavec J, Audié M, Savale L, Jais X, Montani D, Sitbon O, Feuillet S, Mercier O, Petit J, Humbert M, Fadel E, Belli E, Hascoët S. Thirty years of surgical management of pediatric pulmonary hypertension: Mid-term outcomes following reverse Potts shunt and transplantation. J Thorac Cardiovasc Surg 2024; 168:943-954. [PMID: 38052251 DOI: 10.1016/j.jtcvs.2023.11.045] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2023] [Revised: 11/13/2023] [Accepted: 11/15/2023] [Indexed: 12/07/2023]
Abstract
BACKGROUND Reverse Potts shunt (RPS) and lung or heart-lung transplantation are life-extending surgical interventions for pediatric patients with severe pulmonary arterial hypertension (PAH). Robust criteria for identifying patients who will benefit from these procedures remain elusive. Based on 30 years of experience, we sought to refine the surgical indications. METHODS This single-center retrospective cohort study included 61 consecutive pediatric patients with PAH managed by RPS (2004-2020) or transplantation (1988-2020). Their mid-term outcomes were assessed. RESULTS Compared with the 20 patients managed by RPS, the 41 transplant waitlist patients, of whom 28 were transplanted, were older (14.9 vs 8.0 years, P = .0001), had worse right ventricular impairment (tricuspid annular plane systolic excursion, 12.5 mm vs 18.0 mm, P = .03), and were managed later in the evolution of the disease (6.0 vs 1.7 years, P = .002). After implementation of a high-priority allocation program in 2007, waitlist mortality decreased from 52.6% to 13.6% (P = .02) and 5-year survival increased from 57.1% to 74.7% after RPS and 55.6% to 77.2% after transplantation. At a median follow-up of 8.6 years after RPS and 5.9 years after transplantation, functional capacity had improved significantly, and PAH-specific drug requirements had diminished markedly in the RPS group. Two patients successfully underwent double-lung transplant 6 and 9 years after RPS. CONCLUSIONS In selected children with suprasystemic PAH, RPS is associated with functional capacity improvements and decreased pharmacotherapy needs over the midterm. RPS deserves consideration earlier in the course of pediatric PAH, with transplantation being performed in the event of refractory RV failure.
Collapse
Affiliation(s)
- Estibaliz Valdeolmillos
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Jérôme Le Pavec
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Marion Audié
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France
| | - Laurent Savale
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Xavier Jais
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - David Montani
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Olivier Sitbon
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Séverine Feuillet
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Olaf Mercier
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Jérôme Petit
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Marc Humbert
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France; Assistance Publique-Hôpitaux de Paris (AP-HP), Department of Respiratory and Intensive Care Medicine, Pulmonary Hypertension National Referral Center, Hôpital Bicêtre, Faculté de médecine, Université Paris Saclay, Le Kremlin-Bicêtre, France
| | - Elie Fadel
- INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France; Department of Thoracic and Vascular Surgery, Centre de Référence de l'Hypertension Artérielle Pulmonaire Sévère, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Emre Belli
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France
| | - Sébastien Hascoët
- Department of Congenital Heart Diseases, Centre de Référence Malformations Cardiaques Congénitales Complexes M3C, Hôpital Marie Lannelongue, Groupe Hospitalier Paris-Saint Joseph, Faculté de Médecine, Université Paris Saclay, Le Plessis-Robinson, France; INSERM UMR_S 999, Pulmonary Hypertension: Pathophysiology and Novel Therapies, Hôpital Marie Lannelongue, Université Paris-Saclay, Le Plessis-Robinson, France.
| |
Collapse
|
2
|
Li M, Kim JB, Sastry BKS, Chen M. Infective endocarditis. Lancet 2024; 404:377-392. [PMID: 39067905 DOI: 10.1016/s0140-6736(24)01098-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Revised: 05/07/2024] [Accepted: 05/24/2024] [Indexed: 07/30/2024]
Abstract
First described more than 350 years ago, infective endocarditis represents a global health concern characterised by infections affecting the native or prosthetic heart valves, the mural endocardium, a septal defect, or an indwelling cardiac device. Over recent decades, shifts in causation and epidemiology have been observed. Echocardiography remains pivotal in the diagnosis of infective endocarditis, with alternative imaging modalities gaining significance. Multidisciplinary management requiring expertise of cardiologists, cardiovascular surgeons, infectious disease specialists, microbiologists, radiologists and neurologists, is imperative. Current recommendations for clinical management often rely on observational studies, given the limited number of well conducted randomised controlled trials studying infective endocarditis due to the rarity of the disease. In this Seminar, we provide a comprehensive overview of optimal clinical practices in infective endocarditis, highlighting key aspects of pathophysiology, pathogens, diagnosis, management, prevention, and multidisciplinary approaches, providing updates on recent research findings and addressing remaining controversies in diagnostic accuracy, prevention strategies, and optimal treatment.
Collapse
Affiliation(s)
- Mingfang Li
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China
| | - Joon Bum Kim
- Department of Thoracic and Cardiovascular Surgery, Aortic Center, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - B K S Sastry
- Department of Cardiology, Renova Century Hospital, Hyderabad, Telangana, India
| | - Minglong Chen
- Division of Cardiology, the First Affiliated Hospital of Nanjing Medical University, Nanjing, Jiangsu, China.
| |
Collapse
|
3
|
Hascoët S, Bentham JR, Giugno L, Betrián-Blasco P, Kempny A, Houeijeh A, Baho H, Sharma SR, Jones MI, Biernacka EK, Combes N, Georgiev S, Bouvaist H, Martins JD, Kantzis M, Turner M, Schubert S, Jalal Z, Butera G, Malekzadeh-Milani S, Valdeolmillos E, Karsenty C, Ödemiş E, Aldebert P, Haas NA, Khatib I, Wåhlander H, Gaio G, Mendoza A, Arif S, Castaldi B, Dohlen G, Carere RG, Del Cerro-Marin MJ, Kitzmüller E, Hermuzi A, Carminati M, Guérin P, Tengler A, Fraisse A. Outcomes of transcatheter pulmonary SAPIEN 3 valve implantation: an international registry. Eur Heart J 2024; 45:198-210. [PMID: 37874971 DOI: 10.1093/eurheartj/ehad663] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2023] [Revised: 09/11/2023] [Accepted: 09/25/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND AND AIMS Transcatheter pulmonary valve implantation (TPVI) is indicated to treat right-ventricular outflow tract (RVOT) dysfunction related to congenital heart disease (CHD). Outcomes of TPVI with the SAPIEN 3 valve that are insufficiently documented were investigated in the EUROPULMS3 registry of SAPIEN 3-TPVI. METHODS Patient-related, procedural, and follow-up outcome data were retrospectively assessed in this observational cohort from 35 centres in 15 countries. RESULTS Data for 840 consecutive patients treated in 2014-2021 at a median age of 29.2 (19.0-41.6) years were obtained. The most common diagnosis was conotruncal defect (70.5%), with a native or patched RVOT in 50.7% of all patients. Valve sizes were 20, 23, 26, and 29 mm in 0.4%, 25.5%, 32.1%, and 42.0% of patients, respectively. Valve implantation was successful in 98.5% [95% confidence interval (CI), 97.4%-99.2%] of patients. Median follow-up was 20.3 (7.1-38.4) months. Eight patients experienced infective endocarditis; 11 required pulmonary valve replacement, with a lower incidence for larger valves (P = .009), and four experienced pulmonary valve thrombosis, including one who died and three who recovered with anticoagulation. Cumulative incidences (95%CI) 1, 3, and 6 years after TPVI were as follows: infective endocarditis, 0.5% (0.0%-1.0%), 0.9% (0.2%-1.6%), and 3.8% (0.0%-8.4%); pulmonary valve replacement, 0.4% (0.0%-0.8%), 1.3% (0.2%-2.4%), and 8.0% (1.2%-14.8%); and pulmonary valve thrombosis, 0.4% (0.0%-0.9%), 0.7% (0.0%-1.3%), and 0.7% (0.0%-1.3%), respectively. CONCLUSIONS Outcomes of SAPIEN 3 TPVI were favourable in patients with CHD, half of whom had native or patched RVOTs.
Collapse
Affiliation(s)
- Sebastien Hascoët
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
- Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - James R Bentham
- Leeds Teaching Hospitals NHS Trust, Yorkshire Heart Centre, Leeds, UK
| | - Luca Giugno
- Department of Paediatric Cardiology and Adults with congenital heart diseases, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato, Milan, Italy
| | - Pedro Betrián-Blasco
- Hospital Universitario Vall d'Hebron, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Passeig de la Vall d'Hebron, 119, 08035 Barcelona, Spain
| | - Aleksander Kempny
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| | - Ali Houeijeh
- Centre Hospitalier Universitaire de Lille, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, 2 Av. Oscar Lambret, 59000 Lille, France
| | - Haysam Baho
- King Faisal Specialist Hospital, Department of Paediatric Cardiology and Adults with congenital heart diseases, Jeddah, Saudi Arabia
| | - Shiv-Raj Sharma
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| | - Matthew I Jones
- Evelina London Children's Hospital & St Thomas' Hospital, Departement of Paediatric Cardiology and Adults with Congenital Heart Diseases, Westminster Bridge Rd, London SE1 7EH, United Kingdom
| | - Elżbieta Katarzyna Biernacka
- Cardinal Stefan Wyszyński Institute of Cardiology, Department of Congenital Heart Diseases, Alpejska 42, 04-628 Warsaw, Poland
| | - Nicolas Combes
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Clinique Pasteur, Department of Cardiology, 31000 Toulouse, France
| | - Stanimir Georgiev
- Department of Congenital Heart Disease and Pediatric Cardiogy, German Heart Centre Munich, Technical University of Munich, Munich, Germany
| | - Hélène Bouvaist
- Service de Cardiologie, CHU Grenoble Alpes, Grenoble, France
| | - Jose Diogo Martins
- Paediatric Cardiology Department, Hospital de Santa Marta, Centro Hospitalar Universitário de Lisboa Central-EPE, Lisbon, Portugal
| | - Marinos Kantzis
- Glenfield Hosp, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Leicester, United Kingdom
| | - Mark Turner
- Bristol Heart Institute, University Hospitals Bristol & Weston NHS Foundation Trust, Bristol, United Kingdom
| | - Stephan Schubert
- Centre for Congenital Heart Defects, Heart and Diabetes Centre Universitario North Rhine Westphalia, Department for Congenital Heart Defects, Ruhr University Bochum, 32545 Bad Oeynhausen, Germany
| | - Zakaria Jalal
- Pediatric and congenital heart diseases department, Bordeaux University Hospital, Pessac, France
- IHU LIRYC, Electrophysiology and Heart Modeling Institute, CRCTB INSERM U1045, Bordeaux, France
| | - Gianfranco Butera
- Cardiology, Cardiac Surgery and Heart Lung transplantation, ERN GUARD HEART: Bambino Gesù Hospital and Research Institute, IRCCS, Rome, Italy
| | - Sophie Malekzadeh-Milani
- M3C-Necker, Hôpital Universitaire Necker-Enfants malades, Hôpital Européen Georges Pompidou, Assistance Publique-Hôpitaux de Paris (AP-HP), Paris, France
| | - Estibaliz Valdeolmillos
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de médecine Paris-Saclay, Université Paris-Saclay, BME laboratory, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
- Inserm UMR-S 999, Marie Lannelongue hospital, Paris-Saclay university, 133 avenue de la résistance, 92350 Le Plessis Robinson, France
| | - Clement Karsenty
- CHU Hôpital des enfants, Department of Paediatric Cardiology, Toulouse, France
| | - Ender Ödemiş
- Koç University Hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Davutpaşa Cd, 34010 Istanbul, Turkey
| | - Philippe Aldebert
- CHU Timone, Assistance Publique des Hôpitaux de Marseille, 278 rue Saint-Pierre, 13385 Marseille, France
| | - Nikolaus A Haas
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilian University of Munich, Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Ihab Khatib
- Department of Paediatric Cardiology and Congenital Heart Disease in Adults, Rambam Healthcare Campus, Haifa, Israel
- Department of Paediatric Cardiology and Congenital Heart Disease in Adults, Sheba Medical Center, Tel HaShomer Hospital, Ramat Gan, Israël
| | - Håkan Wåhlander
- Paediatric Heart Centre, Queen Silvia Children's Hospital, Sahlgrenska University Hospital and Department of Paediatrics, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Gianpiero Gaio
- Paediatric Cardiology, Ospedali dei Colli, Luigi Vanvitelli University of Campania, Str. Vicinale Reggente, 66/82, 80131 Naples, Italy
| | - Alberto Mendoza
- Instituto Pediátrico del Corazón, Hospital Universitario 12 de Octubre, Av de Cordoba s/n, 28041 Madrid, Spain
| | - Sayqa Arif
- University Hospital Birmingham NHS Trust, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Mindelsohn Way, Birmingham B15 2GW, United Kingdom
| | - Biagio Castaldi
- Paediatric Cardiology Unit, Department of Child and Woman's Health, University of Padua, Via VIII Febbraio, 2, 35122 Padua, Italy
| | - Gaute Dohlen
- University hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, Oslo, Norway
| | - Ronald G Carere
- St Paul's Hospital, Department of Paediatric Cardiology and Adults with Congenital Heart Diseases, 1081 Burrard St, Vancouver, British Columbia V6Z 1Y6, Canada
| | - Maria Jesus Del Cerro-Marin
- Department of Paediatric Cardiology and Adults Congenital Heart Disease, H. Ramón y Cajal University Hospital, Madrid, Spain
| | - Erwin Kitzmüller
- Vienna General Hospital (AKH), Vienna Medical University, Vienna, Austria
| | - Antony Hermuzi
- The Newcastle upon Tyne Hospitals NHS Foundation Trust, Freeman Hospital Newcastle upon Tyne, Newcastle, United Kingdom
| | - Mario Carminati
- Department of Paediatric Cardiology and Adults with congenital heart diseases, IRCCS-Policlinico San Donato, Via Morandi, 30, 20097 San Donato, Milan, Italy
| | - Patrice Guérin
- Centre Hospitalier Universitaire de Nantes, Department of Cardiology, 1 Pl. Alexis-Ricordeau, 44093 Nantes, France
| | - Anja Tengler
- Department of Pediatric Cardiology and Intensive Care, Medical Hospital of the University of Munich, LMU Ludwig Maximilian University of Munich, Campus Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany
| | - Alain Fraisse
- Royal Brompton Hospital, Sydney Street, London, Greater London SW3 6NP, UK
| |
Collapse
|
4
|
Boucek DM, Qureshi AM, Aggarwal V, Spigel ZA, Johnson J, Gray RG, Martin MH. Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. Cardiol Young 2023; 33:2282-2290. [PMID: 36705001 DOI: 10.1017/s104795112200405x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
OBJECTIVES To determine the safety and feasibility of over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement. BACKGROUND Transcatheter pulmonary valve placement is an alternative to surgical pulmonary valve replacement. Traditionally, it was thought to be unsafe to expand a conduit to >110% of its original size. METHODS This retrospective cohort study from two centers includes patients with right ventricle to pulmonary artery conduits with attempted transcatheter pulmonary valve placement from 2010 to 2017. Demographic, procedural, echocardiographic and follow-up data, and complications were evaluated in control and overdilation (to >110% original conduit size) groups. RESULTS One hundred and seventy-two patients (51 overdilation and 121 control) had attempted transcatheter pulmonary valve placement (98% successful). The overdilation group was younger (11.2 versus 16.7 years, p < 0.001) with smaller conduits (15 versus 22 mm, p < 0.001); however, the final valve size was not significantly different (19.7 versus 20.2 mm, p = 0.2). Baseline peak echocardiographic gradient was no different (51.8 versus 55.6 mmHg, p = 0.3). Procedural complications were more frequent in overdilation (18%) than control (7%) groups (most successfully addressed during the procedure). One patient from each group required urgent surgical intervention, with no procedural mortality. Follow-up echocardiographic peak gradients were similar (24.1 versus 26 mmHg, p = 0.5). CONCLUSIONS Over-expansion of right ventricle to pulmonary artery conduits during transcatheter pulmonary valve placement can be performed successfully. Procedural complications are more frequent with conduit overdilation, but there was no difference in the rate of life-threatening complications. There was no difference in valve function at most recent follow-up, and no difference in rate of reintervention. The long-term outcomes of transcatheter pulmonary valve placement with conduit over-expansion requires further study.
Collapse
Affiliation(s)
- Dana M Boucek
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Athar M Qureshi
- The Lillie Frank Abercrombie Section of Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Varun Aggarwal
- Division of Pediatric Cardiology, Department of Pediatrics, University of Minnesota, Masonic Children's Hospital, Minneapolis, MN, USA
| | - Zachary A Spigel
- Department of Surgery, Allegheny Health Network Medical Education Consortium, Pittsburgh, PA, USA
| | - Joyce Johnson
- Department of Pediatric Cardiology, John's Hopkins All Children's Hospital, St. Petersburg, FL, USA
| | - Robert G Gray
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| | - Mary Hunt Martin
- Department of Pediatric Cardiology, University of Utah, Primary Children's Hospital, Salt Lake City, UT, USA
| |
Collapse
|
5
|
Delgado V, Ajmone Marsan N, de Waha S, Bonaros N, Brida M, Burri H, Caselli S, Doenst T, Ederhy S, Erba PA, Foldager D, Fosbøl EL, Kovac J, Mestres CA, Miller OI, Miro JM, Pazdernik M, Pizzi MN, Quintana E, Rasmussen TB, Ristić AD, Rodés-Cabau J, Sionis A, Zühlke LJ, Borger MA. 2023 ESC Guidelines for the management of endocarditis. Eur Heart J 2023; 44:3948-4042. [PMID: 37622656 DOI: 10.1093/eurheartj/ehad193] [Citation(s) in RCA: 259] [Impact Index Per Article: 259.0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023] Open
|
6
|
Slouha E, Johnson LL, Thirunavukarasu A, Al-Geizi H, Clunes LA, Kollias TF. Risk of Infective Endocarditis Post-transcatheter Pulmonary Valve Replacement Versus Surgical Pulmonary Valve Replacement: A Systematic Review. Cureus 2023; 15:e48022. [PMID: 38034152 PMCID: PMC10687661 DOI: 10.7759/cureus.48022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2023] [Indexed: 12/02/2023] Open
Abstract
Pulmonary valve replacement (PVR) is the most common cardiac operation in adult patients with congenital heart disease (ACHD). It can improve right ventricular outflow tract (RVOT) obstruction, typically due to pulmonary valve stenosis or regurgitation. PVR can be performed surgically (open-heart) and through a transcatheter (percutaneous) method, which is minimally invasive and is associated with shorter hospitalization stays. However, following PVR, infectious endocarditis (IE) can complicate the recovery process and increase mortality in the long term. IE is a rare but deadly multi-organ system condition caused by microorganisms traversing the bloodstream from a specific entry point. It can have many presentations, such as splinter hemorrhages, fevers, and vegetation on valves that lead to stroke consequences. This paper aims to evaluate the differences in the rate, etiology, manifestations, treatment, and outcomes of IE following surgical and transcatheter PVR, as the goal is to perform a procedure with few complications. In both approaches, Staphylococcus aureus was the most common microorganism that affected the valves, followed by Streptococcus viridians. Research has shown that surgical pulmonary valve replacement (SPVR) has a decreased risk of IE following surgery compared to TPVR. However, TPVR is preferred due to the reduced overall risk and complications of the procedure. Despite this, the consensus on mortality rates does differ. Future research should consider the type of valves used for transcatheter pulmonary valve replacement (TPVR), such as Melody valves versus Edward Sapien valves, as their IE rates vary significantly.
Collapse
Affiliation(s)
- Ethan Slouha
- Anatomical Sciences, St. George's University School of Medicine, St. George's, GRD
| | - Lashawnd L Johnson
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | | | - Hanin Al-Geizi
- Pharmacology, St. George's University School of Medicine, St. George's, GRD
| | - Lucy A Clunes
- Pharmacology, St George's University School of Medicine, St George's, GRD
| | - Theofanis F Kollias
- Microbiology, Immunology and Pharmacology, St. George's University School of Medicine, St. George's, GRD
| |
Collapse
|
7
|
Lu X, Kelley G, Wang M, Guo X, Han L, Kassab GS. Performance of xenogeneic pulmonary visceral pleura as bioprosthetic heart valve cusps in swine. Front Cardiovasc Med 2023; 10:1213398. [PMID: 37600031 PMCID: PMC10433919 DOI: 10.3389/fcvm.2023.1213398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 07/20/2023] [Indexed: 08/22/2023] Open
Abstract
Objective Bovine pericardium is common biological material for bioprosthetic heart valve. There remains a significant need, however, to improve bioprosthetic valves for longer-term outcomes. This study aims to evaluate the chronic performance of bovine pulmonary visceral pleura (PVP) as bioprosthetic valve cusps. Methods The PVP was extracted from the bovine lung and fixed in 0.625% glutaraldehyde overnight at room temperature. The PVP valve cusps for the bioprosthetic valve were tailored using a laser cutter. Three leaflets were sewn onto a nitinol stent. Six PVP bioprosthetic valves were loaded into the test chamber of the heart valve tester to complete 100 million cycles. Six other PVP bioprosthetic valves were transcardially implanted to replace pulmonary artery valve of six pigs. Fluoroscopy and intracardiac echocardiography were used for in vivo assessments. Thrombosis, calcification, inflammation, and fibrosis were evaluated in the terminal study. Histologic analyses were used for evaluations of any degradation or calcification. Results All PVP bioprosthetic valves completed 100 million cycles without significant damage or tears. In vivo assessments showed bioprosthetic valve cusps open and coaptation at four months post-implant. No calcification and thrombotic deposits, inflammation, and fibrosis were observed in the heart or pulmonary artery. The histologic analyses showed complete and compact elastin and collagen fibers in the PVP valve cusps. Calcification-specific stains showed no calcific deposit in the PVP valve cusps. Conclusions The accelerated wear test demonstrates suitable mechanical strength of PVP cusps for heart valve. The swine model demonstrates that the PVP valve cusps are promising for valve replacement.
Collapse
Affiliation(s)
- Xiao Lu
- Department of Bioengineering, California Medical Innovations Institute, San Diego, CA, United States
| | - Greg Kelley
- Department of Research and Development, 3 DT Holdings, LLC, San Diego, CA, United States
| | - Mengjun Wang
- Department of Research and Development, 3 DT Holdings, LLC, San Diego, CA, United States
| | - Xiaomei Guo
- Department of Bioengineering, California Medical Innovations Institute, San Diego, CA, United States
| | - Ling Han
- Department of Bioengineering, California Medical Innovations Institute, San Diego, CA, United States
| | - Ghassan S. Kassab
- Department of Bioengineering, California Medical Innovations Institute, San Diego, CA, United States
| |
Collapse
|
8
|
Machanahalli Balakrishna A, Dilsaver DB, Aboeata A, Gowda RM, Goldsweig AM, Vallabhajosyula S, Anderson JH, Simard T, Jhand A. Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies. J Clin Med 2023; 12:4886. [PMID: 37568289 PMCID: PMC10419461 DOI: 10.3390/jcm12154886] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2023] [Revised: 07/20/2023] [Accepted: 07/23/2023] [Indexed: 08/13/2023] Open
Abstract
BACKGROUND Transcatheter pulmonary valve implantation (TPVI) is an effective non-surgical treatment method for patients with right ventricle outflow tract dysfunction. The Medtronic Melody and the Edwards Sapien are the two valves approved for use in TPVI. Since TPVI patients are typically younger, even a modest annual incidence of infective endocarditis (IE) is significant. Several previous studies have shown a growing risk of IE after TPVI. There is uncertainty regarding the overall incidence of IE and differences in the risk of IE between the valves. METHODS A systematic search was conducted in the MEDLINE, EMBASE, PubMed, and Cochrane databases from inception to 1 January 2023 using the search terms 'pulmonary valve implantation', 'TPVI', or 'PPVI'. The primary outcome was the pooled incidence of IE following TPVI in Melody and Sapien valves and the difference in incidence between Sapien and Melody valves. Fixed effect and random effect models were used depending on the valve. Meta-regression with random effects was conducted to test the difference in the incidence of IE between the two valves. RESULTS A total of 22 studies (including 10 Melody valve studies, 8 Sapien valve studies, and 4 studies that included both valves (572 patients that used the Sapien valve and 1395 patients that used the Melody valve)) were used for the final analysis. Zero IE incidence following TPVI was reported by eight studies (66.7%) that utilized Sapien valves compared to two studies (14.3%) that utilized Melody valves. The pooled incidence of IE following TPVI with Sapien valves was 2.1% (95% CI: 0.9% to 5.13%) compared to 8.5% (95% CI: 4.8% to 15.2%) following TPVI with Melody valves. Results of meta-regression indicated that the Sapien valve had a 79.6% (95% CI: 24.2% to 94.4%, p = 0.019; R2 = 34.4) lower risk of IE incidence compared to the Melody valve. CONCLUSIONS The risk of IE following TPVI differs significantly. A prudent valve choice in favor of Sapien valves to lower the risk of post-TPVI endocarditis may be beneficial.
Collapse
Affiliation(s)
| | - Danielle B. Dilsaver
- Department of Medicine, Division of Clinical Research and Public Health, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Ahmed Aboeata
- Division of Cardiovascular Medicine, Department of Medicine, Creighton University School of Medicine, Omaha, NE 68124, USA
| | - Ramesh M. Gowda
- Department of Interventional Cardiology, Icahn School of Medicine at Mount Sinai Morningside and Beth Israel, New York, NY 10029, USA
| | - Andrew M. Goldsweig
- Department of Cardiovascular Medicine, Baystate Medical Center, Springfield, MA 01199, USA
- Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE 68105, USA
| | - Saraschandra Vallabhajosyula
- Section of Cardiovascular Medicine, Department of Medicine, Wake Forest University School of Medicine, Winston-Salem, NC 27101, USA
| | - Jason H. Anderson
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Trevor Simard
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| | - Aravdeep Jhand
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, USA
| |
Collapse
|
9
|
Lourtet-Hascoët J, Valdeolmillos E, Houeijeh A, Bonnet E, Karsenty C, Sharma SR, Kempny A, Iung B, Gatzoulis MA, Fraisse A, Hascoët S. Infective endocarditis after transcatheter pulmonary valve implantation in patients with congenital heart disease: Distinctive features. Arch Cardiovasc Dis 2023; 116:159-166. [PMID: 36842868 DOI: 10.1016/j.acvd.2023.01.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/18/2023]
Abstract
The introduction of transcatheter pulmonary valve implantation (TPVI) has greatly benefited the management of right ventricular outflow tract dysfunction. Infective endocarditis (IE) is a feared complication of TPVI that affects valve durability and patient outcomes. Current recommendations provide only limited guidance on the management of IE after TPVI (TPVI-IE). This article, by a group of experts in congenital heart disease in children and adults, interventional cardiology, infectious diseases including IE, and microbiology, provides a comprehensive review of the current evidence on TPVI-IE, including its incidence, risk factors, causative organisms, diagnosis, and treatment. The incidence of TPVI-IE varies from 13-91/1000 person-years for Melody valves to 8-17/1000 person-years for SAPIEN valves. Risk factors include history of IE, DiGeorge syndrome, immunosuppression, male sex, high residual transpulmonary gradient and portal of bacteria entry. Staphylococci and streptococci are the most common culprits, whereas Staphylococcus aureus is associated with the most severe disease. In addition to the modified Duke criteria, a high residual gradient warrants a strong suspicion. Imaging studies are helpful for the diagnosis. Intravenous antibiotics guided by blood culture results are the mainstay of treatment. Invasive re-intervention may be required. TPVI-IE in patients with congenital heart disease exhibits several distinctive features. Whether specific valve types are associated with a higher risk of TPVI-IE requires further investigation. Patient and parent education regarding IE prevention may have a role to play and should be offered to all patients.
Collapse
Affiliation(s)
- Julie Lourtet-Hascoët
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; Clinical Microbiology Laboratory, Hôpital Saint Joseph, Groupe Hospitalier Paris Saint Joseph, 75014 Paris, France
| | - Estibaliz Valdeolmillos
- Pôle des cardiopathies congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes-réseau M3C, Faculté de Médecine, Université Paris-Saclay, INSERM UMR-S999, BME Lab, 92350 Le Plessis-Robinson, France
| | - Ali Houeijeh
- Department of Congenital Heart Disease, Lille University Hospital, 59000 Lille, France
| | - Eric Bonnet
- Infectious Diseases Mobile Unit, Clinique Pasteur, 31000 Toulouse, France
| | - Clément Karsenty
- Cardiologie pédiatrie, Hôpital des enfants, Centre de Compétence Cardiopathies Congénitales Complexes-réseau M3C- CHU Toulouse, 31000 Toulouse, France
| | - Shiv-Raj Sharma
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Aleksander Kempny
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Bernard Iung
- Service de Cardiologie, Hôpital Bichat, AP-HP, Université Paris-Cité, 75018 Paris, France
| | - Michael A Gatzoulis
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; National Heart and Lung Institute, Imperial College, SW3 6LY London, UK
| | - Alain Fraisse
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK
| | - Sébastien Hascoët
- Department of Pediatric Cardiology and Adults with Congenital Heart Disease Centre, Royal Brompton Hospital, SW3 6NP London, UK; Pôle des cardiopathies congénitales, Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Centre de Référence Cardiopathies Congénitales Complexes-réseau M3C, Faculté de Médecine, Université Paris-Saclay, INSERM UMR-S999, BME Lab, 92350 Le Plessis-Robinson, France.
| |
Collapse
|
10
|
Lourtet-Hascoët J, Valdeolmillos E, Houeijeh A, Kantzis M, Alvarez-Fuente M, Guérin P, Jones M, Georgiev S, Ystgaard MB, Betrian P, Fraisse A, Hascoët S. SAPIEN valve infective endocarditis after transcatheter pulmonary valve replacement: A European case series. Arch Cardiovasc Dis 2023; 116:109-111. [PMID: 36669930 DOI: 10.1016/j.acvd.2022.11.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Revised: 11/21/2022] [Accepted: 11/23/2022] [Indexed: 01/07/2023]
Affiliation(s)
- Julie Lourtet-Hascoët
- Clinical Microbiology Laboratory, Saint Joseph Hospital, groupe hospitalier Paris Saint-Joseph, 75014 Paris, France; Department of Paediatric Cardiology, Royal Brompton Hospital, SW3 6NP London, UK
| | - Estibaliz Valdeolmillos
- Marie-Lannelongue Hospital, M3C Network, groupe hospitalier Paris Saint-Joseph, Paris-Saclay University, 92350 Le Plessis-Robinson, France; Inserm UMR-S 999, Marie-Lannelongue Hospital, Paris-Saclay University, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France
| | - Ali Houeijeh
- Department of Congenital Heart Disease, Lille University Hospital, 59000 Lille, France
| | - Marinos Kantzis
- Department of Congenital Heart Disease, University Hospital of Leicester, LE3 9QP Leicester, UK
| | - Maria Alvarez-Fuente
- Department of Paediatric Cardiology and ACHD, Ramón y Cajal University Hospital, 28034 Madrid, Spain
| | - Patrice Guérin
- Department of Cardiology, Nantes University Hospital, 44093 Nantes, France
| | - Matthew Jones
- Department of Paediatric Cardiology, Evelina London Children's Hospital, SE1 7EH, London, UK
| | | | | | - Pedro Betrian
- Department of Paediatric Cardiology, University Hospital Vall d'Hebron, 08035 Barcelona, Spain
| | - Alain Fraisse
- Department of Paediatric Cardiology, Royal Brompton Hospital, SW3 6NP London, UK
| | - Sebastien Hascoët
- Department of Paediatric Cardiology, Royal Brompton Hospital, SW3 6NP London, UK; Marie-Lannelongue Hospital, M3C Network, groupe hospitalier Paris Saint-Joseph, Paris-Saclay University, 92350 Le Plessis-Robinson, France; Inserm UMR-S 999, Marie-Lannelongue Hospital, Paris-Saclay University, 133, avenue de la Résistance, 92350 Le Plessis-Robinson, France.
| |
Collapse
|
11
|
MacDonald ST, Bhan A, Khambadkone S, Mullen M. Percutaneous heart valves demonstrating long-term durability: A case series of Melody valves in the pulmonary position lasting up to 19 years. Catheter Cardiovasc Interv 2023; 101:401-406. [PMID: 36626279 DOI: 10.1002/ccd.30534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 12/04/2022] [Accepted: 12/16/2022] [Indexed: 01/11/2023]
Abstract
It is uncertain how long catheter delivered percutaneous heart valves may last. In congenital cardiology, stenosis and regurgitation of right ventricular to pulmonary artery conduits and valves is common, leading to repeated operations for young patients with concomitant mortality and morbidity. It has also been unclear whether percutaneous pulmonary valves last as long as surgical pulmonary valves. When the current generation of the percutaneous pulmonary valve was first implanted in the United Kingdom from 2003, randomized trials were initially not performed, decided on a case-by-case basis in congenital cardiology, nor long-term registries kept. We describe three cases where such percutaneous heart valves have lasted up to 19 years. All valves were working without significant stenosis and minor degrees of regurgitation on long-term echocardiographic follow-up, patients being asymptomatic. This demonstrates that percutaneous pulmonary valves can achieve long-term durability and may prevent the need for otherwise high-risk surgery in congenital cardiac patients.
Collapse
Affiliation(s)
| | - Amit Bhan
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| | - Sachin Khambadkone
- Department of Paediatric Cardiology, Great Ormond Street Hospital, London, UK
| | - Michael Mullen
- Barts Heart Centre, St Bartholomew's Hospital, London, UK
| |
Collapse
|
12
|
Houeijeh A, Batteux C, Karsenty C, Ramdane N, Lecerf F, Valdeolmillos E, Lourtet-Hascoet J, Cohen S, Belli E, Petit J, Hascoët S. Long-term outcomes of transcatheter pulmonary valve implantation with melody and SAPIEN valves. Int J Cardiol 2023; 370:156-166. [PMID: 36283540 DOI: 10.1016/j.ijcard.2022.10.141] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/17/2022] [Revised: 10/16/2022] [Accepted: 10/19/2022] [Indexed: 11/05/2022]
Abstract
BACKGROUND Transcatheter pulmonary valve implantation (TPVI) is effective for treating right ventricle outflow tract (RVOT) dysfunction. Factors associated with long-term valve durability remain to be investigated. METHODS Consecutive patients successfully treated by TPVI with Melody valves (n = 32) and SAPIEN valves (n = 182) between 2008 and 2020 at a single tertiary centre were included prospectively and monitored. RESULTS The 214 patients had a median age of 28 years (range, 10-81). The RVOT was a patched native pulmonary artery in 96 (44.8%) patients. Median follow-up was 2.8 years (range, 3 months-11.4 years). Secondary pulmonary valve replacement (sPVR) was performed in 23 cases (10.7%), due to stenosis (n = 22, 95.7%) or severe regurgitation (n = 1, 4.3%), yielding an incidence of 7.6/100 patient-years with melody valves and 1.3/100 patient-years with SAPIEN valves (P = 0.06). The 5- and 10-year sPVR-freedom rates were 78.1% and 50.4% with Melody vs. 94.3% and 82.2% with SAPIEN, respectively (P = 0.06). The incidence of infective endocarditis (IE) was 5.5/100 patient-years with Melody and 0.2/100 patient-years with SAPIEN (P < 0.0001). Factors associated with sPVR by univariate analysis were RV obstruction before TPVI (P = 0.04), transpulmonary maximal velocity > 2.7 m/s after TPVI (p = 0.0005), valve diameter ≤ 22 mm (P < 0.003), IE (P < 0.0001), and age < 25 years at TPVI (P = 0.04). By multivariate analysis adjusted for IE occurrence, transpulmonary maximal velocity remained associated with sPVR. CONCLUSIONS TPVI is effective for treating RVOT dysfunction. Incidence of sPVR is higher in patients with residual RV obstruction or IE. IE add a substantial risk of TPVI graft failure and is mainly linked to the Melody valve. SOCIAL MEDIA ABSTRACT Transcatheter pulmonary valve implantation is effective for treating right ventricular outflow tract dysfunction in patients with congenital heart diseases. Incidence of secondary valve replacement is higher in patients with residual obstruction or infective endocarditis.
Collapse
Affiliation(s)
- Ali Houeijeh
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Department of Congenital Heart Disease, Lille University Hospital, Faculté de médecine, Laboratoire EA4489, Université Lille II, Lille, France.
| | - Clement Batteux
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Clement Karsenty
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Service de cardiologie pédiatrique, Hôpital des Enfants, CHU de Toulouse, 330 avenue de Grande-Bretagne, Toulouse, France.
| | - Nassima Ramdane
- Department of Congenital Heart Disease, Lille University Hospital, Faculté de médecine, Laboratoire EA4489, Université Lille II, Lille, France.
| | - Florence Lecerf
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, Faculté de médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Estibaliz Valdeolmillos
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, Faculté de médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Julie Lourtet-Hascoet
- Service de microbiologie Clinique, Hôpital Saint-Joseph, Groupe Hospitalier Paris Saint Joseph, 185 rue Raymond Losserand, Paris, France.
| | - Sarah Cohen
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Emre Belli
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Jérôme Petit
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| | - Sébastien Hascoët
- Department of Congenital Heart Disease, Marie Lannelongue Hospital, BME lab, Centre Constitutif Réseau M3C Cardiopathies Congénitales Complexes, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France; Inserm UMR-S 999, Hôpital Marie Lannelongue, Faculté de médecine, Université Paris-Saclay, 133 avenue de la résistance, 92350 Le Plessis Robinson, France.
| |
Collapse
|
13
|
Çekirdekçi EI, Bugan B, Onar LÇ, Çekirdekçi A. Infective endocarditis after transcatheter approach versus surgical pulmonary valve replacement: A meta-analysis. TURK GOGUS KALP DAMAR CERRAHISI DERGISI 2022; 30:472-483. [PMID: 36303703 PMCID: PMC9580299 DOI: 10.5606/tgkdc.dergisi.2022.23506] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/21/2022] [Accepted: 04/05/2022] [Indexed: 06/16/2023]
Abstract
BACKGROUND In this meta-analysis, we aimed to assess the risk of infective endocarditis in transcatheter versus surgical pulmonary valve replacement patients. METHODS We systematically searched PubMed, Cochrane, EMBASE, Scopus, and Web of Science for the studies that reported the event rate of infective endocarditis in both transcatheter and surgical pulmonary valve replacement between December 2012 and December 2021. Random-effects model was used in the meta-analysis. RESULTS Fifteen comparison groups with 4,706 patients were included. The mean follow-up was 38.5±3.7 months. Patients with transcatheter pulmonary valve replacement had a higher risk of infective endocarditis than patients receiving surgically replaced valves (OR 2.68, 95% CI: 1.83-3.93, p<0.00001). The calculated absolute risk difference was 0.03 (95% CI: 0.01-0.05), indicating that if 1,000 patients received a surgical valve replacement, 30 cases of infective endocarditis would be prevented. A meta-regression of follow-up time on the incidence of infective endocarditis was not statistically significant (p=0.753). CONCLUSION Although transcatheter pulmonary valve replacement is a feasible alternative to surgical replacement in severe right ventricular outflow tract dysfunction, the higher incidence of infective endocarditis in transcatheter replacement remains a significant concern. Regarding this analysis, surgical treatment of right ventricular outflow tract dysfunction is still a viable option in patients with prohibitive risk.
Collapse
Affiliation(s)
- Elif Ijlal Çekirdekçi
- Department of Cardiology, University of Kyrenia, Kyrenia, Turkish Republic of Northern Cyprus
| | - Barış Bugan
- Department of Cardiology, Gülhane Training and Research Hospital, Ankara, Türkiye
| | - Lütfi Çağatay Onar
- Department of Cardiovascular Surgery, Dr. Ismail Fehmi Cumalioglu Government Hospital, Tekirdağ, Türkiye
| | - Ahmet Çekirdekçi
- Department of Cardiovascular Surgery, Kütahya Health Science University, Kütahya, Türkiye
| |
Collapse
|
14
|
Ahmed HF, Thangappan K, Haney LC, Zafar F, Lehenbauer DG, Tweddell JS, Hirsch R, Elminshawy A, Morales DLS. Endocarditis in Bovine Vein Grafts in the Pulmonary Position Placed Surgically & Percutaneously. World J Pediatr Congenit Heart Surg 2022; 13:155-165. [PMID: 35238702 DOI: 10.1177/21501351211065363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background: Infective endocarditis (IE) is one of the major complications following pulmonary valve replacement (PVR). This analysis hopes to evaluate the incidence, outcomes and possible risk factors of IE associated with trans-catheter and surgical placement of a bovine jugular vein (BJV) graft in the pulmonary position. Methods: In this single-center retrospective study, all records of trans-catheter and surgical PVR from 3/2010 to 12/2019 were reviewed. IE was defined as positive blood cultures, with vegetations seen on echocardiography or sudden increase in peak gradient across the valve or vegetations confirmed at time of valve replacement. Poor dental hygiene:1.dental procedures without S.B.E prophylaxis AND/OR 2.one or more dental cavities, caries, dental abscess. Results: 165 patients had PVR with BJV:107 trans-catheter and 63 surgical. 7%(12/170) of PVRs developed IE(catheter:n = 10, surgery:n = 2) at a median time from valve placement of 38 months. The incidence of IE in the catheter group:3-per-100patient-years and in surgical group:1-per-100patient-years. Multivariate cox regression showed that poor dental hygiene was significantly associated with IE [HR(95% CI):16.9(4.35-66.2)](p value <.001). Kaplan-Meier curves showed a significant difference in freedom from IE between patients with poor and appropriate dental hygiene (p value<.001). Conclusions: There is a 7% incidence of IE with the use of BJV grafts in the pulmonary position at mid-term follow-up. Though the rate in catheter placed BJV seems 3x higher than surgically placed ones, their cohorts are quite different making this comparison flawed. Poor dental hygiene is a strong predictor for post-operative IE and offers a significant opportunity for lowering the rate of infective endocarditis.
Collapse
Affiliation(s)
- Hosam F Ahmed
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA.,68797Department of Cardiothoracic Surgery, Assiut University, Assiut, Egypt
| | | | - Li Cai Haney
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Farhan Zafar
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | | | - James S Tweddell
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Russel Hirsch
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Ahmed Elminshawy
- 68797Department of Cardiothoracic Surgery, Assiut University, Assiut, Egypt
| | - David L S Morales
- 2518Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
15
|
Venet M, Jalal Z, Ly R, Malekzadeh-Milani S, Hascoët S, Fournier E, Ovaert C, Casalta AC, Karsenty C, Baruteau AE, Le Gloan L, Selegny M, Douchin S, Bouvaist H, Belaroussi Y, Camou F, Tlili G, Thambo JB. Diagnostic Value of 18F-Fluorodeoxyglucose Positron Emission Tomography Computed Tomography in Prosthetic Pulmonary Valve Infective Endocarditis. JACC Cardiovasc Imaging 2021; 15:299-308. [PMID: 34538632 DOI: 10.1016/j.jcmg.2021.07.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 06/23/2021] [Accepted: 07/06/2021] [Indexed: 02/05/2023]
Abstract
OBJECTIVES The aim of this study was to assess the diagnostic performances of 18F-fluorodeoxyglucose (18F-FDG) positron emission tomography (PET)/computed tomography (CT) in congenital heart disease (CHD) patients with pulmonary prosthetic valve or conduit endocarditis (PPVE) suspicion. BACKGROUND PPVE is a major issue in the growing CHD population. Diagnosis is challenging, and usual imaging tools are not always efficient or validated in this specific population. Particularly, the diagnostic yield of 18F-FDG PET/CT remains poorly studied in PPVE. METHODS A retrospective multicenter study was conducted in 8 French tertiary centers. Children and adult CHD patients who underwent 18F-FDG PET/CT in the setting of PPVE suspicion between January 2010 and May 2020 were included. The cases were initially classified as definite, possible, or rejected PPVE regarding the modified Duke criteria and finally by the Endocarditis Team consensus. The result of 18F-FDG PET/CT had been compared with final diagnosis consensus used as gold-standard in our study. RESULTS A total of 66 cases of PPVE suspicion involving 59 patients (median age 23 years, 73% men) were included. Sensitivity, specificity, positive predictive value, and negative predictive value of 18F-FDG PET/CT in PPVE suspicion were respectively: 79.1% (95% CI: 68.4%-91.4%), 72.7% (95% CI: 60.4%-85.0%), 91.9% (95% CI: 79.6%-100.0%), and 47.1% (95% CI: 34.8%-59.4%). 18F-FDG PET/CT findings would help to correctly reclassify 57% (4 of 7) of possible PPVE to definite PPVE. CONCLUSIONS Using 18F-FDG PET/CT improves the diagnostic accuracy of the Duke criteria in CHD patients with suspected PPVE. Its high positive predictive value could be helpful in routine to shorten diagnosis and treatment delays and improve clinical outcomes.
Collapse
Affiliation(s)
- Maëlys Venet
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France.
| | - Zakaria Jalal
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| | - Reaksmei Ly
- Congenital Heart Diseases Unit, Hôpital Européen Georges-Pompidou, Paris, France
| | | | - Sebastien Hascoët
- Paris-Sud Faculty of Medicine, Marie-Lannelongue Hospital, Paris, Saclay, Le Plessis-Robinson, France
| | - Emmanuelle Fournier
- Paris-Sud Faculty of Medicine, Marie-Lannelongue Hospital, Paris, Saclay, Le Plessis-Robinson, France
| | - Caroline Ovaert
- Pediatric and Congenital Cardiology Department, La Timone University Hospital, Marseille, France
| | - Anne Claire Casalta
- Pediatric and Congenital Cardiology Department, La Timone University Hospital, Marseille, France
| | - Clément Karsenty
- Pediatric Cardiology Unit, Children's Hospital, CHU Toulouse, France
| | - Alban Elouen Baruteau
- L'institut du thorax, Congenital and Pediatric Cardiology Unit, CHU de Nantes, Nantes, France; Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Children's Hospital, CHU Nantes, Nantes, France, (j)Pediatric-Cardiology, Amiens-Picardie University Hospital, Amiens, France
| | - Laurianne Le Gloan
- L'institut du thorax, Congenital and Pediatric Cardiology Unit, CHU de Nantes, Nantes, France; Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Children's Hospital, CHU Nantes, Nantes, France, (j)Pediatric-Cardiology, Amiens-Picardie University Hospital, Amiens, France
| | - Maëlle Selegny
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, Children's Hospital, CHU Nantes, Nantes, France, (j)Pediatric-Cardiology, Amiens-Picardie University Hospital, Amiens, France
| | | | | | - Yaniss Belaroussi
- INSERM, Bordeaux Population Health Research Center, ISPED, University of Bordeaux, Bordeaux, France, (n)INSERM CIC1401, Clinical and Epidemiological Research Unit, Institut Bergonié, Bordeaux, France; Cardiology Department, CHU Grenoble, Grenoble, France; Department of Thoracic Surgery, Haut-Leveque Hospital, Bordeaux University, Bordeaux, France
| | - Fabrice Camou
- Medical Intensive Care Unit, Hôpital Saint André, CHU de Bordeaux, Bordeaux, France
| | - Ghoufrane Tlili
- Nuclear Medicine Department, Hôpital cardiologique du Haut Lévêque, CHU de Bordeaux, Pessac, France
| | - Jean-Benoît Thambo
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France; IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France; INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, Bordeaux, France
| |
Collapse
|
16
|
McElhinney DB, Zhang Y, Aboulhosn JA, Morray BH, Biernacka EK, Qureshi AM, Torres AJ, Shahanavaz S, Goldstein BH, Cabalka AK, Bauser-Heaton H, Georgiev S, Berger F, Millan-Iturbe O, Peng LF, Armstrong AK, Levi DS, Fronczak-Jakubczyk A, Sondergaard L, Anderson JH, Schranz D, Jones TK, Cheatham JP, Schubert S, Ewert P. Multicenter Study of Endocarditis After Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2021; 78:575-589. [PMID: 34353535 DOI: 10.1016/j.jacc.2021.05.044] [Citation(s) in RCA: 42] [Impact Index Per Article: 14.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Revised: 04/02/2021] [Accepted: 05/18/2021] [Indexed: 01/18/2023]
Abstract
BACKGROUND Endocarditis has emerged as one of the most impactful adverse events after transcatheter pulmonary valve replacement (TPVR), but there is limited information about risk factors for and outcomes of this complication. OBJECTIVES The purpose of this study was to evaluate risk factors for and outcomes of endocarditis in a large multicenter cohort. METHODS The authors established an international registry focused on characterizing endocarditis after TPVR, including the incidence, risk factors, characteristics, and outcomes. RESULTS Investigators submitted data for 2,476 patients who underwent TPVR between July 2005 and March 2020 and were followed for 8,475 patient-years. In total, 182 patients were diagnosed with endocarditis a median of 2.7 years after TPVR, for a cumulative incidence of 9.5% (95% CI: 7.9%-11.1%) at 5 years and 16.9% (95% CI: 14.2%-19.8%) at 8 years (accounting for competing risks: death, heart transplant, and explant) and an annualized incidence of 2.2 per 100 patient-years. Staphylococcus aureus and Viridans group Streptococcus species together accounted for 56% of cases. Multivariable analysis confirmed that younger age, a previous history of endocarditis, and a higher residual gradient were risk factors for endocarditis, but transcatheter pulmonary valve type was not. Overall, right ventricular outflow tract (RVOT) reintervention was less often to treat endocarditis than for other reasons, but valve explant was more often caused by endocarditis. Endocarditis was severe in 44% of patients, and 12 patients (6.6%) died, nearly all of whom were infected with Staphylococcus aureus. CONCLUSIONS The incidence of endocarditis in this multicenter registry was constant over time and consistent with prior smaller studies. The findings of this study, along with ongoing efforts to understand and mitigate risk, will be critical to improve the lifetime management of patients with heart disease involving the RVOT. Although endocarditis can be a serious adverse outcome, TPVR remains an important tool in the management of RVOT dysfunction.
Collapse
Affiliation(s)
| | - Yulin Zhang
- Stanford University School of Medicine, Palo Alto, California, USA
| | - Jamil A Aboulhosn
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Brian H Morray
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | | | - Alejandro J Torres
- New York-Presbyterian Morgan Stanley Children's Hospital, Columbia University Medical Center, New York, New York, USA
| | - Shabana Shahanavaz
- Washington University in St. Louis School of Medicine, St. Louis, Missouri, USA
| | - Bryan H Goldstein
- Cincinnati Children's Hospital, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
| | | | - Holly Bauser-Heaton
- Sibley Heart Center at Children's Healthcare of Atlanta, Atlanta, Georgia, USA
| | | | | | - Oscar Millan-Iturbe
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark; Centro Medico Nacional Siglo XXI, Mexico City, Mexico
| | - Lynn F Peng
- Stanford University School of Medicine, Palo Alto, California, USA
| | | | - Daniel S Levi
- Mattel Children's Hospital at UCLA, Los Angeles, California, USA
| | | | - Lars Sondergaard
- Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | | | | | - Thomas K Jones
- Seattle Children's Hospital, University of Washington, Seattle, Washington, USA
| | | | - Stephan Schubert
- Deutsches Herzzentrum Berlin, Berlin, Germany; Ruhr University of Bochum, Bad Oeynhausen, Germany
| | | |
Collapse
|
17
|
Georgiev S, Ewert P, Eicken A, Hager A, Hörer J, Cleuziou J, Meierhofer C, Tanase D. Munich Comparative Study: Prospective Long-Term Outcome of the Transcatheter Melody Valve Versus Surgical Pulmonary Bioprosthesis With Up to 12 Years of Follow-Up. Circ Cardiovasc Interv 2021; 13:e008963. [PMID: 32600110 DOI: 10.1161/circinterventions.119.008963] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Percutaneous pulmonary valve implantation (PPVI) has become an important treatment of right ventricular outflow tract dysfunction. Studies directly comparing the long-term outcome of PPVI with the Melody valve to surgical pulmonary valve replacement (SPVR) are lacking. METHODS All patients treated with PPVI with the Melody valve and SPVR between January 2006 and December 2018 in our center were enrolled into a database and investigated with a standard follow-up protocol. The current study compares the outcomes in means of survival, reinterventions, infectious endocarditis, and performance of the valves. RESULTS The study included 452 patients, of whom 241 were treated with PPVI with the Melody valve and 211 patients with SPVR with different types of valves. Median follow-up time was 5.4 years (3 months to 12.5 years), and the total observation was 2449 patient-years. Estimated survival after 10 years was 94% in the Melody group and 92% in the SPVR group (P=0.47). There was no difference in the estimated survival free of surgery on the implanted valve at 10 years (Melody, 87%, versus SPVR, 87%; P=0.54) or in the survival with the originally implanted pulmonary valve (Melody group, 80%; SPVR group, 73%; P=0.46) between both groups. The annualized incidence of infective endocarditis was 1.6% in the Melody group and 0.5% in the SPVR group, and the estimated survival free of endocarditis did not differ significantly between groups (Melody group, 82%; SPVR group, 86%; P=0.082). Survival free of valve replacement because of infective endocarditis was comparable between both groups (Melody, 88%; SPVR, 88%; P=0.35). CONCLUSIONS PPVI with the Melody valve and SPVR provides similar survival, freedom of reinterventions, and infective endocarditis with or without the need of replacement of the pulmonary valve. Being less invasive, PPVI should be considered a method for treatment for patients with dysfunctional right ventricular outflow tracts.
Collapse
Affiliation(s)
- Stanimir Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease (S.G., P.E., A.E., A.H., C.M., D.T.), German Heart Center Munich, Technische Universität München
| | - Peter Ewert
- Department of Pediatric Cardiology and Congenital Heart Disease (S.G., P.E., A.E., A.H., C.M., D.T.), German Heart Center Munich, Technische Universität München
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease (S.G., P.E., A.E., A.H., C.M., D.T.), German Heart Center Munich, Technische Universität München
| | - Alfred Hager
- Department of Pediatric Cardiology and Congenital Heart Disease (S.G., P.E., A.E., A.H., C.M., D.T.), German Heart Center Munich, Technische Universität München
| | - Jürgen Hörer
- Department of Congenital and Pediatric Heart Surgery (J.H., J.C.), German Heart Center Munich, Technische Universität München
| | - Julie Cleuziou
- Department of Congenital and Pediatric Heart Surgery (J.H., J.C.), German Heart Center Munich, Technische Universität München
| | - Christian Meierhofer
- Department of Pediatric Cardiology and Congenital Heart Disease (S.G., P.E., A.E., A.H., C.M., D.T.), German Heart Center Munich, Technische Universität München
| | - Daniel Tanase
- Department of Pediatric Cardiology and Congenital Heart Disease (S.G., P.E., A.E., A.H., C.M., D.T.), German Heart Center Munich, Technische Universität München
| |
Collapse
|
18
|
|
19
|
Jalal Z, Valdeolmillos E, Malekzadeh-Milani S, Eicken A, Georgiev S, Hofbeck M, Sieverding L, Gewillig M, Ovaert C, Bouvaist H, Pillois X, Thambo JB, Boudjemline Y. Mid-Term Outcomes Following Percutaneous Pulmonary Valve Implantation Using the "Folded Melody Valve" Technique. Circ Cardiovasc Interv 2021; 14:e009707. [PMID: 33726503 PMCID: PMC8055198 DOI: 10.1161/circinterventions.120.009707] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
Background: The folded valve is a manual shortening of the Melody device, which has been validated as a valuable therapeutic option for the management of dysfunctional right ventricular outflow tracts needing a short valved stent. In this article, we aimed to evaluate, in a multicenter cohort, the mid-term outcomes of patients in whom a percutaneous pulmonary valve implantation was performed using the folded valve technique. Methods: A 2012 to 2018 retrospective multicenter study was performed in 7 European institutions. All patients who benefit from percutaneous pulmonary valve implantation with a folded Melody valve were included. Results: A total of 49 patients (median age, 19 years [range 4–56], 63% male) were included. The primary percutaneous pulmonary valve implantation indication was right ventricular outflow tract stenosis (n=19; 39%), patched native right ventricular outflow tracts were the most common substrate (n=15; 31%). The folded technique was mostly used in short right ventricular outflow tracts (n=28; 57%). Procedural success was 100%. After a median follow-up of 28 months (range, 4–80), folded Melody valve function was comparable to the immediate postimplantation period (mean transvalvular peak velocity=2.6±0.6 versus 2.4±0.6 m/s, P>0.1; only 2 patients had mild pulmonary regurgitation). Incidence rate of valve-related reinterventions was 2.1% per person per year (95% CI, 0.1%–3.9%). The probability of survival without valve-related reinterventions at 36 months was 90% (95% CI, 76%–100%). Conclusions: The folded Melody valve is a safe technique with favorable mid-term outcomes up to 6.5 years after implantation, comparable with the usual Melody valve implantation procedure. Complications and reinterventions rates were low, making this technique relevant in selected patients.
Collapse
Affiliation(s)
- Zakaria Jalal
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France (Z.J., E.V., J.-B.T.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (Z.J., E.V., X.P., J.-B.T.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (Z.J., E.V., X.P., J.-B.T.)
| | - Estíbaliz Valdeolmillos
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France (Z.J., E.V., J.-B.T.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (Z.J., E.V., X.P., J.-B.T.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (Z.J., E.V., X.P., J.-B.T.)
| | - Sophie Malekzadeh-Milani
- Department of Congenital and Pediatric Cardiology, Centre de Reference Malformations Cardiaques Congenitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Pediatric Cardiology, France (S.M.-M.)
| | - Andreas Eicken
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Germany (A.E., S.G.)
| | - Stanimir Georgiev
- Department of Pediatric Cardiology and Congenital Heart Disease, German Heart Center Munich at the TU Munich, Germany (A.E., S.G.)
| | - Michael Hofbeck
- Department of Pediatric Cardiology, University Children's Hospital, Tuebingen, Germany (M.H., L.S.)
| | - Ludger Sieverding
- Department of Pediatric Cardiology, University Children's Hospital, Tuebingen, Germany (M.H., L.S.)
| | - Marc Gewillig
- Department of Pediatric Cardiology, University Hospitals Leuven, Belgium (M.G.)
| | - Caroline Ovaert
- Department of Pediatric Cardiology and Congenital Heart Disease, AP-HM, Timone enfants, Hopital de la Timone, Provence-Alpes-Côte d'Azur, France (C.O.)
| | | | - Xavier Pillois
- IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (Z.J., E.V., X.P., J.-B.T.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (Z.J., E.V., X.P., J.-B.T.)
| | - Jean-Benoit Thambo
- Bordeaux University Hospital (CHU), Department of Pediatric and Adult Congenital Cardiology, Pessac, France (Z.J., E.V., J.-B.T.).,IHU Liryc, Electrophysiology and Heart Modeling Institute, Fondation Bordeaux Université, Pessac-Bordeaux, France (Z.J., E.V., X.P., J.-B.T.).,INSERM, Centre de recherche Cardio-Thoracique de Bordeaux, U1045, France (Z.J., E.V., X.P., J.-B.T.)
| | - Younes Boudjemline
- Cardiac Catheterization Laboratories, Sidra Heart Center, Sidra Medicine, Doha, Qatar (Y.B.)
| |
Collapse
|
20
|
Megaly M, Han K, Sedhom R, Aboulhosn J, Moga F, Mudy K, Daniels MJ, Elbadawi A, Omer M, Mosleh W, Cavalcante JL, Garcia S. Outcomes of percutaneous and surgical pulmonary valve implantation. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2021; 32:27-32. [PMID: 33422413 DOI: 10.1016/j.carrev.2020.12.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2020] [Revised: 12/21/2020] [Accepted: 12/21/2020] [Indexed: 10/22/2022]
Abstract
BACKGROUND The objective of this study is to describe the recent trends and in-hospital outcomes with percutaneous pulmonic valve implantation (PPVI) and surgical pulmonic valve implantation (SPVR) in adult hospitals in the US after the availability of both the Melody valve (Medtronic Inc., Minneapolis, Minnesota) and the Sapien XT valve (Edwards Lifesciences, Irvine, CA). METHODS We queried the National Inpatient Sample database (NIS) from January 2016 to December 2017 to identify hospitalizations for PPVI and SPVR. RESULTS We identified 5455 weighted discharges with PPVI and SPVR (PPVI=1140, SPVR=4305). PPVI procedures had increased in number over 2016 and 2017 (115 procedure at the first quarter of 2016, 195 procedures in the final quarter of 2017, P-trend=0.086), while SPVR volume remained constant. The incidence of in-hospital mortality was low with both procedures (SPRV: 1.6% vs. PPVI: 0.9%, p=0.071). SPVR had worse in-hospital outcomes, was associated with a longer length of stay [5 days vs. 1 day, p<0.001], and comparable cost of index hospitalization [$51,657 vs. $51,193] compared with PPVI. CONCLUSION After approval of the Sapien valve for commercial use in 2016, PPVI procedures have increased in frequency. PPVI is associated with lower procedural complications than SPVR, however, both carry a low risk of mortality. Despite the higher cost of the valves and delivery systems, PPVI is associated with a slightly lower cost of index hospitalization compared with SPVR, likely due to the higher in-hospital complications and LOS of the latter.
Collapse
Affiliation(s)
- Michael Megaly
- Banner University Medical Center-UA college of Medicine, Phoenix, AZ, United States of America
| | - Kelly Han
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Ramy Sedhom
- Department of Medicine, Albert Einstein Medical Center, Philadelphia, PA, United States of America
| | - Jamil Aboulhosn
- Department of Pediatric Interventional Cardiology, UCLA, Los Angeles, CA, United States of America
| | - Francis Moga
- Division of Pediatric Cardiothoracic Surgery, Children's Heart Clinic, Minneapolis, MN, United States of America
| | - Karol Mudy
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Matthew J Daniels
- Manchester Heart Centre, Manchester Royal Infirmary, Manchester University NHS Foundation Trust, UK
| | - Ayman Elbadawi
- Division of Cardiology, University of Texas Medical Branch, Galveston, TX, United States of America
| | - Mohamed Omer
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Wassim Mosleh
- Division of Cardiology, University of Connecticut, Farmington, CT, United States of America
| | - João L Cavalcante
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America
| | - Santiago Garcia
- Minneapolis Heart Institute, Abbott Northwestern Hospital, Minneapolis, MN, United States of America.
| |
Collapse
|
21
|
McElhinney DB. Prevention and management of endocarditis after transcatheter pulmonary valve replacement: current status and future prospects. Expert Rev Med Devices 2020; 18:23-30. [PMID: 33246368 DOI: 10.1080/17434440.2021.1857728] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Introduction: Transcatheter pulmonary valve replacement (TPVR) has become an important tool in the management of congenital heart disease with abnormalities of the right ventricular outflow tract. Endocarditis is one of the most serious adverse long-term outcomes and among the leading causes of death in patients with congenital heart disease and after (TPVR).Areas covered: This review discusses the current state knowledge about the risk factors for and outcomes of endocarditis after transcatheter pulmonary valve replacement in patients with congenital and acquired heart disease. It also addresses practical measures for mitigating endocarditis risk, as well as diagnosing and managing endocarditis when it does occur.Expert opinion: With increasing understanding of the risk factors for and management and outcomes of endocarditis in patients who have undergone TPVR, we continue to learn how to utilize TPVR most effectively in this complex population of patients.
Collapse
Affiliation(s)
- Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA
| |
Collapse
|
22
|
Bos D, De Wolf D, Cools B, Eyskens B, Hubrechts J, Boshoff D, Louw J, Frerich S, Ditkowski B, Rega F, Meyns B, Budts W, Sluysmans T, Gewillig M, Heying R. Infective endocarditis in patients after percutaneous pulmonary valve implantation with the stent-mounted bovine jugular vein valve: Clinical experience and evaluation of the modified Duke criteria. Int J Cardiol 2020; 323:40-46. [PMID: 32860844 DOI: 10.1016/j.ijcard.2020.08.058] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2020] [Revised: 07/21/2020] [Accepted: 08/17/2020] [Indexed: 01/11/2023]
Abstract
AIMS Percutaneous pulmonary valve implantation (PPVI) has proven good hemodynamic results. As infective endocarditis (IE) remains a potential complication with limited available clinical data, we reviewed our patient records to improve future strategies of IE prevention, diagnosis and treatment. METHODS Medical records of all patients diagnosed with Melody® valve IE according to the modified Duke criteria were retrospectively analyzed in three Belgian tertiary centers. RESULTS 23 IE episodes in 22 out of 240 patients were identified (incidence 2.4% / patient year) with a clear male predominance (86%). Median age at IE was 17.9 years (range 8.2-45.9 years) and median time from PPVI to IE was 2.4 years (range 0.7-8 years). Streptococcal species caused 10 infections (43%), followed by Staphylococcus aureus (n = 5, 22%). In 13/23 IE episodes a possible entry-point was identified (57%). IE was classified as definite in 15 (65%) and as possible in 8 (35%) cases due to limitations of imaging. Echocardiography visualized vegetations in only 10 patients. PET-CT showed positive FDG signals in 5/7 patients (71%) and intracardiac echocardiography a vegetation in 1/1 patient (100%). Eleven cases (48%) had a hemodynamically relevant pulmonary stenosis at IE presentation. Nine early and 6 late percutaneous or surgical re-interventions were performed. No IE related deaths occurred. CONCLUSIONS IE after Melody® valve PPVI is associated with a relevant need of re-interventions. Communication to patients and physicians about risk factors is essential in prevention. The modified Duke criteria underperformed in diagnosing definite IE, but inclusion of new imaging modalities might improve diagnostic performance.
Collapse
Affiliation(s)
- D Bos
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - D De Wolf
- Pediatric Cardiology, University Hospital of Ghent, Belgium
| | - B Cools
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - B Eyskens
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - J Hubrechts
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - D Boshoff
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - J Louw
- Pediatric Cardiology, AZM, Maastricht, the Netherlands
| | - S Frerich
- Pediatric Cardiology, AZM, Maastricht, the Netherlands
| | - B Ditkowski
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - F Rega
- Division of Clinical Cardiac Surgery, KU Leuven, Leuven, Belgium
| | - B Meyns
- Division of Clinical Cardiac Surgery, KU Leuven, Leuven, Belgium
| | - W Budts
- Congenital and Structural Cardiology, University Hospitals Leuven, and Department of Cardiovascular Sciences, Catholic University Leuven, Belgium
| | - T Sluysmans
- Pediatric Cardiology, Cliniques Universitaires St. Luc, Brussels, Belgium
| | - M Gewillig
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium
| | - R Heying
- Pediatric Cardiology, Department of Cardiovascular Developmental Biology, University Hospitals Leuven, Belgium,.
| |
Collapse
|
23
|
Recurrent infective endocarditis in a patient after a second Melody valve placement. Cardiol Young 2020; 30:1050-1051. [PMID: 32498746 DOI: 10.1017/s1047951120001389] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
A 16-year-old Caucasian male was diagnosed with recurrent infective endocarditis associated with his second Melody valve placed inside a previously treated infected Melody valve. The replacement of Melody valve after the first infective endocarditis episode might increase the risk of the second episode of infective endocarditis.
Collapse
|
24
|
Gavotto A, Werner O, Amedro P. Late infective endocarditis after transcatheter tricuspid valve-in-valve implantation: A pediatric case report. Arch Pediatr 2020; 27:107-109. [DOI: 10.1016/j.arcped.2019.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Revised: 10/04/2019] [Accepted: 12/30/2019] [Indexed: 10/25/2022]
|
25
|
Thambo JB. Transcatheter interventions in congenital heart disease: We must have the means to fulfil our ambitions. Arch Cardiovasc Dis 2020; 113:89-91. [PMID: 31983654 DOI: 10.1016/j.acvd.2019.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2019] [Revised: 12/16/2019] [Accepted: 12/17/2019] [Indexed: 10/25/2022]
Affiliation(s)
- Jean-Benoît Thambo
- French Group of Paediatric and Adult Congenital Cardiology, French Society of Cardiology, 75012 Paris, France; French Working Group of Interventional Paediatric and Adult Congenital Cardiology, France; Department of Paediatric and Adult Congenital Cardiology, Bordeaux University Hospital (CHU), 33600 Pessac, France; IHU Liryc, Electrophysiology and Heart Modelling Institute, Fondation Bordeaux Université, 33600 Pessac, France; Centre de Recherche Cardio-Thoracique de Bordeaux, Inserm, U1045, 33000 Bordeaux, France.
| |
Collapse
|
26
|
Abstract
The annual incidence of infective endocarditis (IE) is estimated to be between 15 and 80 cases per million persons in population-based studies. The incidence of IE is markedly increased in patients with valve prostheses (>4 per 1,000) or with prior IE (>10 per 1,000). The interaction between platelets, microorganisms and diseased valvular endothelium is the cause of vegetations and valvular or perivalvular tissue destruction. Owing to its complexity, the diagnosis of IE is facilitated by the use of the standardized Duke-Li classification, which combines two major criteria (microbiology and imaging) with five minor criteria. However, the sensitivity of the Duke-Li classification is suboptimal, particularly in prosthetic IE, and can be improved by the use of PET or radiolabelled leukocyte scintigraphy. Prolonged antibiotic therapy is mandatory. Indications for surgery during acute IE depend on the presence of haemodynamic, septic and embolic complications. The most urgent indications for surgery are related to heart failure. In the past decade, the prevention of IE has been reoriented, with indications for antibiotic prophylaxis now limited to patients at high risk of IE undergoing dental procedures. Guidelines now emphasize the importance of nonspecific oral and cutaneous hygiene in individual patients and during health-care procedures.
Collapse
|
27
|
Greutmann M, Benson L, Silversides CK. Percutaneous Valve Interventions in the Adult Congenital Heart Disease Population: Emerging Technologies and Indications. Can J Cardiol 2019; 35:1740-1749. [PMID: 31813506 DOI: 10.1016/j.cjca.2019.10.019] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2019] [Revised: 10/01/2019] [Accepted: 10/17/2019] [Indexed: 11/28/2022] Open
Abstract
Adult survivors with congenital heart disease are not cured and residual cardiac valve lesions are common and contribute substantially to long-term morbidity. Given the increased risk of reoperations in patients with previous cardiac surgery, percutaneous treatment options have been developed. Initially percutaneous therapies focused on right ventricular outflow tract lesions, but they have now expanded to include mitral and aortic valve interventions. Although some of these procedures, such as balloon valvuloplasty of pulmonary valve stenosis and percutaneous pulmonary valve replacement, have become standard of care, there are many new and evolving technologies that will likely become important treatment strategies over the coming decade. The key for success of these transcatheter valve procedures is the careful evaluation of the patient's individual anatomy and physiology and a multidisciplinary assessment involving cardiologists specialized in adult congenital heart disease, specialized imagers, cardiac surgeons, and interventionalists. Because many of these percutaneous interventions are relatively new, long-term outcomes are not yet well defined, dictating the need for careful and structured long-term observational studies on outcomes of these novel procedures, which will allow refining the indications of a specific intervention and to improve its technical aspects. The aim of this article is to provide an overview of common valve lesions in the adult congenital heart disease population and to discuss treatment options and strategies with a specific focus on percutaneous options.
Collapse
Affiliation(s)
- Matthias Greutmann
- University Heart Centre, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
| | - Lee Benson
- Toronto Congenital Cardiac Centre for Adults, University Health Network, Division of Cardiology, University of Toronto, Toronto, Ontario, Canada; Labatt Family Heart Centre, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Candice K Silversides
- Toronto Congenital Cardiac Centre for Adults, Division of Cardiology, University of Toronto, Mount Sinai Hospital, University Health Network, Toronto, Ontario, Canada
| |
Collapse
|
28
|
Driesen BW, Warmerdam EG, Sieswerda GJ, Meijboom FJ, Molenschot MMC, Doevendans PA, Krings GJ, van Dijk APJ, Voskuil M. Percutaneous Pulmonary Valve Implantation: Current Status and Future Perspectives. Curr Cardiol Rev 2019; 15:262-273. [PMID: 30582483 PMCID: PMC8142351 DOI: 10.2174/1573403x15666181224113855] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 12/12/2018] [Accepted: 12/17/2018] [Indexed: 02/07/2023] Open
Abstract
Patients with congenital heart disease (CHD) with right ventricle outflow tract (RVOT) dysfunction need sequential pulmonary valve replacements throughout their life in the majority of cases. Since their introduction in 2000, the number of percutaneous pulmonary valve implantations (PPVI) has grown and reached over 10,000 procedures worldwide. Overall, PPVI has been proven safe and effective, but some anatomical variations can limit procedural success. This review discusses the current status and future perspectives of the procedure.
Collapse
Affiliation(s)
- Bart W Driesen
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Cardiology, Radboudumc, Nijmegen, Netherlands
| | | | - Gert-Jan Sieswerda
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | - Folkert J Meijboom
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Pieter A Doevendans
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands.,Netherlands Heart Institute, Utrecht, Netherlands.,Central Military Hospital, Utre cht, Netherlands
| | - Gregor J Krings
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| | | | - Michiel Voskuil
- Department of Cardiology, University Medical Center Utrecht, Utrecht, Netherlands
| |
Collapse
|
29
|
Guerin P, Fresse KW, Razafimahatratra O. [Percutaneous treatment of the pulmonary valve]. Ann Cardiol Angeiol (Paris) 2019; 68:474-479. [PMID: 31694766 DOI: 10.1016/j.ancard.2019.10.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2019] [Accepted: 10/03/2019] [Indexed: 10/25/2022]
Abstract
Right ventricular outflow tract diseases are historically outcomes of surgical reconstruction for heart defects in neonates or children (Tetralogy of Fallot, Ross surgery). This kind of surgery performed during childhood lead often to dysfunctional right ventricular outflow tract (stenosis, leak) in older infants or young adults. In this case, reintervention on the right ventricular outflow tract would be associated with a high surgical risk. Development of the first percutaneous valves in the year 2000 paved the way for the pulmonary revalvulation. This percutaneous procedure has emerged as a credible alternative to the surgery for multioperated high risk patients with congenital cardiopathies. Two valves are currently available on the French market (Melody®, Sapien®); they cover all therapy indications, except the example of very wide outflow tracts which remain a surgical issue. Medical teams in charge of these young patients have to be enough trained in order to limit risks during the procedure. To this end, several teams promote the percutaneous pulmonary revalvulation over surgical revalvulation, this latter becoming limited only to cases in which percutaneous treatment is not feasible.
Collapse
Affiliation(s)
- P Guerin
- Centre cardio-thoracique de Monaco, 11, bis avenue d'Ostende, B.P. 223, 98004 Monaco cedex, France.
| | - K Warin Fresse
- Imagerie cardio-vasculaire, CHU de Nantes, quai Moncousu, 44093 Nantes cedex 1, France
| | - O Razafimahatratra
- Centre cardio-thoracique de Monaco, 11, bis avenue d'Ostende, B.P. 223, 98004 Monaco cedex, France
| |
Collapse
|
30
|
The risk of infective endocarditis following interventional pulmonary valve implantation: A meta-analysis. J Cardiol 2019; 74:197-205. [DOI: 10.1016/j.jjcc.2019.04.007] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Revised: 02/22/2019] [Accepted: 04/13/2019] [Indexed: 11/19/2022]
|
31
|
Elzein FE, Alsherbeeni N, Alnajashi K, Alsufyani E, Akhtar MY, Albalawi R, Albarrag AM, Kaabia N, Mehdi S, Alzahrani A, Raoult D. Ten-year experience of Q fever endocarditis in a tertiary cardiac center in Saudi Arabia. Int J Infect Dis 2019; 88:21-26. [PMID: 31382048 DOI: 10.1016/j.ijid.2019.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Revised: 06/21/2019] [Accepted: 07/29/2019] [Indexed: 10/26/2022] Open
Abstract
BACKGROUND Q fever endocarditis (QFE) is considered rare in the Middle East, with only a few cases reported in Saudi Arabia. The aim of this study is to report on the experience of our centre on QFE. METHODS We searched the medical records for cases of QFE at our cardiac center from 2009-2018. Demographic data, clinical features, serology and echocardiography results, treatments, and outcomes were assessed. RESULTS Five hundred and two cases of infective endocarditis were detected over the 10 years period. Among the 234 patients with blood culture-negative endocarditis (BCNE), 19 (8.10%) had QFE. All patients had a previously diagnosed congenital heart disease except for one patient with rheumatic heart disease. Eleven patients had received a bovine jugular vein-related implant, e.g., a Melody valve (seven patients) or Contegra conduit (four patients). Coinfection was detected in three patients, and immunologic and embolic phenomena were observed in five patients. All patients received a combination of hydroxychloroquine and doxycycline, with good outcomes. Only two patients required surgery while on treatment. Two patients died several months after treatment; the cause of death was not identified. CONCLUSION This study indicates that Q fever exists in our population. The majority of the patients had congenital heart disease (CHD) and underwent bovine jugular vein implants. Patients with CHD are at increased risk of infective endocarditis. Bovine jugular vein implants increase the risk of infective and possibly QFE. Proper exclusion of Q fever is warranted in all BCNE and possibly in culture-positive endocarditis cases in areas endemic to Q fever. KEY POINTS We presented the largest series of Q fever endocarditis cases in Saudi Arabia. We showed that Q fever is not rare in the Middle East and suggest that it should be considered in all blood culture-negative endocarditis cases.
Collapse
Affiliation(s)
- Fatehi E Elzein
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia.
| | - Nisreen Alsherbeeni
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Eid Alsufyani
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - M Y Akhtar
- Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | - Rashed Albalawi
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | | | - Naoufel Kaabia
- Infectious Diseases Unit, Prince Sultan Military Medical City (PSMMC), Riyadh, Saudi Arabia
| | - Syed Mehdi
- Prince Sultan Cardiac Centre, Riyadh, Saudi Arabia
| | | | - Didier Raoult
- Aix Marseille Université, MEPHI, IHU-Méditerranée Infection, Marseille, France; IHU-Méditerranée Infection, Marseille, France
| |
Collapse
|
32
|
Iung B. Endocardite infectieuse. Épidémiologie, physiopathologie et anatomopathologie. Presse Med 2019; 48:513-521. [DOI: 10.1016/j.lpm.2019.04.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Accepted: 04/04/2019] [Indexed: 12/18/2022] Open
|
33
|
Morgan GJ. Pulmonary Regurgitation- Is the Future Percutaneous or Surgical? Front Pediatr 2018; 6:184. [PMID: 30042933 PMCID: PMC6048258 DOI: 10.3389/fped.2018.00184] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2018] [Accepted: 06/04/2018] [Indexed: 12/25/2022] Open
Abstract
For decades, surgical replacement of the pulmonary valve has been seen as the gold-standard technique. Until the advent of Medtronic's Melody valve, it was the only option. Whilst radical changes in surgical techniques have not been forthcoming, rapid and substantial developments in the techniques and available technology for percutaneous valves now cause us to ask if the gold-standard moniker now belongs in the cath lab. This manuscript explores the recent history and future of a revolution in this large area of congenital cardiac practice.
Collapse
Affiliation(s)
- Gareth J Morgan
- Congenital Interventional Cardiologist, Heart Institute, Children's Hospital of Colorado, University Colorado Hospital, Colorado University, Denver, CO, United States
| |
Collapse
|