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Egbe AC, Salama AA, Miranda WR, Karnakoti S, Anderson JH, Jain CC, Burchill LJ, Connolly HM. Right Heart Reverse Remodeling and Prosthetic Valve Function After Transcatheter vs Surgical Pulmonary Valve Replacement. JACC Cardiovasc Interv 2024; 17:248-258. [PMID: 38267139 DOI: 10.1016/j.jcin.2023.11.030] [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: 07/09/2023] [Revised: 11/15/2023] [Accepted: 11/16/2023] [Indexed: 01/26/2024]
Abstract
BACKGROUND There are limited data about postprocedural right heart reverse remodeling and long-term prosthesis durability after transcatheter pulmonary valve replacement (TPVR) and how these compare to surgical pulmonary valve replacement (SPVR). OBJECTIVES This study sought to compare right heart reverse remodeling, pulmonary valve gradients, and prosthetic valve dysfunction after TPVR vs SPVR. METHODS Patients with TPVR were matched 1:2 to patients with SPVR based on age, sex, body surface area, congenital heart lesion, and procedure year. Right heart indexes (right atrial [RA] reservoir strain, RA volume index, RA pressure, right ventricular [RV] global longitudinal strain, RV end-diastolic area, and RV systolic pressure) were assessed at baseline (preintervention), 1 year postintervention, and 3 years postintervention. Pulmonary valve gradients were assessed at 1, 3, 5, 7, and 9 years postintervention. RESULTS There were 64 and 128 patients in the TPVR and SPVR groups, respectively. Among patients with TPVR, 46 (72%) and 18 (28%) received Melody (Medtronic) vs SAPIEN (Edwards Lifesciences) valves, respectively. The TPVR group had greater postprocedural improvement in RA reservoir strain and RV global longitudinal strain at 1 and 3 years. The TPVR group had a higher risk of prosthetic valve dysfunction mostly because of a higher incidence of prosthetic valve endocarditis compared to SPVR but a similar risk of pulmonary valve reintervention because some of the patients with endocarditis received medical therapy only. Both groups had similar pulmonary valve mean gradients at 9 years postintervention. CONCLUSIONS These data suggest a more favorable right heart outcome after TPVR. However, the risk of prosthetic valve endocarditis and prosthetic valve dysfunction remains a major concern.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA.
| | - Abdalla A Salama
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA; Department of Cardiovascular Diseases, Suez Canal University, Ismailia, Egypt
| | - William R Miranda
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Snigdha Karnakoti
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Jason H Anderson
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - C Charles Jain
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Luke J Burchill
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
| | - Heidi M Connolly
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota, USA
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2
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Hascoet S, Karsenty C, Fraisse A. Transcatheter Pulmonary Valve Replacement: History Is on the Move. JACC Cardiovasc Interv 2024; 17:245-247. [PMID: 38267138 DOI: 10.1016/j.jcin.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Accepted: 12/05/2023] [Indexed: 01/26/2024]
Affiliation(s)
- Sébastien Hascoet
- Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine, Paris-Saclay, Université Paris-Saclay, Le Plessis Robinson, France; Royal Brompton Hospital and the National & Heart Institute, Imperial College, London, United Kingdom; Inserm UMR-S 999, Marie Lannelongue Hospital, Paris-Saclay University, Le Plessis Robinson, France.
| | - Clément Karsenty
- Department of Paediatric Cardiology, CHU Toulouse, Toulouse, France
| | - Alain Fraisse
- Royal Brompton Hospital and the National & Heart Institute, Imperial College, London, United Kingdom
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3
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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.
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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
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Manukyan SN, Soynov IA, Voytov AV, Rzaeva KA, Baranov AA, Bogachev-Prokofiev AV. [Modern possibilities for transcatheter pulmonary valve replacement]. Khirurgiia (Mosk) 2024:32-44. [PMID: 38344958 DOI: 10.17116/hirurgia202402132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/15/2024]
Abstract
The literature review is devoted to transcatheter pulmonary valve replacement. The authors summarize the indications, clinical data and current capabilities of transcatheter pulmonary valve replacement. The authors also overviewed modern valves for transcatheter pulmonary artery replacement. Effectiveness of transcatheter pulmonary valve implantation has been substantiated. Various studies comparing the outcomes of different valve systems for endovascular implantation were analyzed. The authors concluded the prospects for transcatheter pulmonary valve implantation.
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Affiliation(s)
- S N Manukyan
- Meshalkin National Medical Research, Novosibirsk, Russia
| | - I A Soynov
- Meshalkin National Medical Research, Novosibirsk, Russia
| | - A V Voytov
- Meshalkin National Medical Research, Novosibirsk, Russia
| | - K A Rzaeva
- Meshalkin National Medical Research, Novosibirsk, Russia
| | - A A Baranov
- Meshalkin National Medical Research, Novosibirsk, Russia
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5
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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.
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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
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Dardari M, Cinteza E, Vasile CM, Padovani P, Vatasescu R. Infective Endocarditis among Pediatric Patients with Prosthetic Valves and Cardiac Devices: A Review and Update of Recent Emerging Diagnostic and Management Strategies. J Clin Med 2023; 12:4941. [PMID: 37568344 PMCID: PMC10420327 DOI: 10.3390/jcm12154941] [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: 06/12/2023] [Revised: 07/13/2023] [Accepted: 07/25/2023] [Indexed: 08/13/2023] Open
Abstract
Infective endocarditis (IE) is a disease of the endocardium, which leads to the appearance of vegetation on the valves, cardiac structures, or, potentially, vascular endothelium of the heart. The risk of IE can be increased more than 140 times by congenital heart disease (50-59% of all IE), particularly if cyanotic. An increase in mortality may result from IE in patients with a complex cardiac pathology or patients with an implanted prosthetic material, most frequently conduits in a pulmonary position. Cardiac implantable electronic devices (CIED) infective endocarditis is a life-threatening complication representing 10% of all cases of endocarditis. Common signs of presentation are often fever and chills; redness and swelling at the pocket of the pacemaker, including the erosion and exteriorization of the device; and life-threatening sepsis. The use of intracardiac echocardiography for the diagnosis of IE is an innovative method. This may be needed, especially in older children undergoing complex cardiac surgery, when transthoracic echocardiography (TTE) and transesophageal echocardiography (TOE) failed to provide a reliable diagnosis. The 2018 European Heart Rhythm Association (EHRA) experts' consensus statement on transvenous lead extraction recommends complete device removal and antimicrobial therapy for any device-related infection, including CIED-IE. The most detected microorganism was Staphylococcus Aureus. In addition, cardiac surgery and interventional cardiology associated with the placement of prostheses or conduits may increase the risk of IE up to 1.6% for Melody valve implantation. Our manuscript presents a comprehensive review of infective endocarditis associated with cardiac devices and prostheses in the pediatric population, including recent advances in diagnosis and management.
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Affiliation(s)
- Mohamed Dardari
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.D.); (R.V.)
- Electrophysiology and Cardiac Pacing Lab., Clinical Emergency Hospital, 014461 Bucharest, Romania
| | - Eliza Cinteza
- Interventional Cardiology Compartment, Marie Sklodowska Curie Children Emergency Hospital, 041451 Bucharest, Romania
- Department of Pediatrics, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania
| | - Corina Maria Vasile
- Pediatric and Adult Congenital Cardiology Department, M3C National Reference Centre, Bordeaux University Hospital, 33600 Bordeaux, France
| | - Paul Padovani
- Nantes Université, CHU Nantes, Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, 44000 Nantes, France;
| | - Radu Vatasescu
- Faculty of Medicine, Carol Davila University of Medicine and Pharmacy, 050474 Bucharest, Romania; (M.D.); (R.V.)
- Electrophysiology and Cardiac Pacing Lab., Clinical Emergency Hospital, 014461 Bucharest, Romania
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7
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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.
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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
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8
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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.
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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.
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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.
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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.
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10
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Sherard C, Atteya M, Vogel AD, Bisbee C, Kang L, Turek JW, Rajab TK. Partial heart transplantation can ameliorate donor organ utilization. J Card Surg 2022; 37:5307-5312. [PMID: 36259737 DOI: 10.1111/jocs.17050] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2022] [Revised: 09/23/2022] [Accepted: 10/05/2022] [Indexed: 01/06/2023]
Abstract
BACKGROUND The treatment of babies with unrepairable heart valve dysfunction remains an unsolved problem because there are no growing heart valve implants. However, orthotopic heart transplants are known to grow with recipients. AIM Partial heart transplantation is a new approach to delivering growing heart valve implants, which involves transplantation of the part of the heart containing the valves only. In this review, we discuss the benefits of this procedure in children with unrepairable valve dysfunction. CONCLUSION Partial heart transplantation can be performed using donor hearts with poor ventricular function and slow progression to donation after cardiac death. This should ameliorate donor heart utilization and avoid both primary orthotopic heart transplantation in children with unrepairable heart valve dysfunction and progression of these children to end-stage heart failure.
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Affiliation(s)
- Curry Sherard
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Miriam Atteya
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Andrew D Vogel
- Department of Surgery, Alabama College of Osteopathic Medicine, Dothan, Alabama, USA
| | - Cora Bisbee
- Department of Surgery, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Lillian Kang
- Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Joseph W Turek
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Taufiek K Rajab
- Section of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
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Lawley CM, Tanous D, O'Donnell C, Anderson B, Aroney N, Walters DL, Shipton S, Wilson W, Celermajer DS, Roberts P. Ten Years of Percutaneous Pulmonary Valve Implantation in Australia and New Zealand. Heart Lung Circ 2022; 31:1649-1657. [PMID: 36038469 DOI: 10.1016/j.hlc.2022.07.008] [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: 06/17/2021] [Revised: 04/28/2022] [Accepted: 07/12/2022] [Indexed: 12/27/2022]
Abstract
OBJECTIVE This study sought to investigate the characteristics, morbidity (including the rate of infective endocarditis and valve replacement) and mortality of individuals undergoing percutaneous pulmonary valve implantation in Australia and New Zealand since the procedure has been performed. BACKGROUND The outcomes of percutaneous pulmonary valve implantation in Australia and New Zealand have not been evaluated. Recent international data, including patients from New Zealand, suggests the rate of infective endocarditis is not insignificant. METHODS A retrospective multi-site cohort study was undertaken via medical record review at the centres where percutaneous pulmonary valve implantation has been performed. All procedures performed from 2009-March 2018 were included. Individuals were identified from local institution databases. Data was collected and analysed including demographics, details at the time of intervention, haemodynamic outcome, post procedure morbidity and mortality. Multi-site ethics approval was obtained. RESULTS One hundred and seventy-nine (179) patients attended the cardiac catheter laboratory for planned percutaneous pulmonary valve implantation. Of these patients, 172 underwent successful implantation. Tetralogy of Fallot and pulmonary atresia were the most common diagnoses. The median age at procedure was 19 years (range 3-60 yrs). There was a significant improvement in the acute haemodynamics in patients undergoing percutaneous pulmonary valve implantation for stenosis. Seven (7) patients (3.9%) experienced a major procedural/early post procedure complication (death, conversion to open procedure, cardiac arrest), including two deaths. The annualised rates of infective endocarditis and valve replacement were 4.6% and 3.8% respectively. There was one death related to infective endocarditis in follow-up. CONCLUSIONS Percutaneous pulmonary valve replacement is a relatively safe method of rehabilitating the right ventricular outflow tract.
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Affiliation(s)
- Claire M Lawley
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia; The University of Sydney Children's Hospital Westmead Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.
| | - David Tanous
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia; Department of Cardiology, Westmead Hospital, Sydney, NSW, Australia
| | - Clare O'Donnell
- Green Lane Paediatric and Congenital Cardiac Service, Starship/Auckland City Hospitals, Starship Children's Hospital, Auckland, New Zealand
| | - Benjamin Anderson
- Queensland Paediatric Cardiac Service, Queensland Children's Hospital, Brisbane, Qld, Australia
| | - Nicholas Aroney
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia
| | - Darren L Walters
- Department of Cardiology, The Prince Charles Hospital, Brisbane, Qld, Australia; The University of Queensland, Brisbane, Qld, Australia
| | - Stephen Shipton
- Children's Cardiac Centre, Perth Children's Hospital, Perth, WA, Australia
| | - William Wilson
- Department of Cardiology, The Royal Melbourne Hospital, Melbourne, Vic, Australia
| | - David S Celermajer
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Philip Roberts
- The Heart Centre for Children, The Children's Hospital at Westmead, Sydney Children's Hospitals Network, Sydney, NSW, Australia
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12
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Kouijzer JJP, Noordermeer DJ, van Leeuwen WJ, Verkaik NJ, Lattwein KR. Native valve, prosthetic valve, and cardiac device-related infective endocarditis: A review and update on current innovative diagnostic and therapeutic strategies. Front Cell Dev Biol 2022; 10:995508. [PMID: 36263017 PMCID: PMC9574252 DOI: 10.3389/fcell.2022.995508] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/06/2022] [Indexed: 11/13/2022] Open
Abstract
Infective endocarditis (IE) is a life-threatening microbial infection of native and prosthetic heart valves, endocardial surface, and/or indwelling cardiac device. Prevalence of IE is increasing and mortality has not significantly improved despite technological advances. This review provides an updated overview using recent literature on the clinical presentation, diagnosis, imaging, causative pathogens, treatment, and outcomes in native valve, prosthetic valve, and cardiac device-related IE. In addition, the experimental approaches used in IE research to improve the understanding of disease mechanisms and the current diagnostic pipelines are discussed, as well as potential innovative diagnostic and therapeutic strategies. This will ultimately help towards deriving better diagnostic tools and treatments to improve IE patient outcomes.
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Affiliation(s)
- Joop J. P. Kouijzer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
- *Correspondence: Joop J. P. Kouijzer,
| | - Daniëlle J. Noordermeer
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Wouter J. van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Nelianne J. Verkaik
- Department of Medical Microbiology and Infectious Diseases, Erasmus MC University Medical Center, Rotterdam, Netherlands
| | - Kirby R. Lattwein
- Thoraxcenter, Department of Biomedical Engineering, Erasmus MC University Medical Center, Rotterdam, Netherlands
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13
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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.
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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
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14
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Canan A, Ocazionez-Trujillo D, Vargas D, Foley TA, Cabalka AK, Rajiah PS. Pre- and Postprocedure Imaging of Transcatheter Pulmonary Valve Implantation. Radiographics 2022; 42:991-1011. [PMID: 35687519 DOI: 10.1148/rg.210160] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Transcatheter pulmonary valve replacement (TPVR) is a minimally invasive procedure for treatment of right ventricular outflow tract (RVOT) dysfunction in surgically repaired congenital heart diseases. TPVR is performed in these patients to avoid the high risk and complexity of repeat surgeries. Several TPVR devices are now available to be placed in the right ventricle (RV) to pulmonary artery (PA) conduit, native RVOT, or surgical bioprosthetic valves. Imaging is used before TPVR to determine patient eligibility and optimal timing, which is critical to avoid irreversible RV dilatation and failure. Imaging is also required for evaluation of contraindications, particularly proximity of the RVOT to the left main coronary artery and its branches. Cross-sectional imaging provides details of the complex anatomy in which the TPVR device will be positioned and measurements of the RVOT, RV-PA conduit, or PA. Echocardiography is the first-line imaging modality for evaluation of the RVOT or conduit to determine the need for intervention, although its utility is limited by the complex RVOT morphology and altered anatomy after surgery. CT and MRI provide complementary information for TPVR, including patient eligibility, assessment of contraindications, and key measurements of the RVOT and PA, which are necessary for procedure planning. TPVR, performed using a cardiac catheterization procedure, includes a sizing step in which a balloon is expanded in the RVOT, which also allows assessment of the risk for extrinsic coronary artery compression. Follow-up imaging with CT and MRI is used for evaluation of postprocedure remodeling and valve function and to monitor complications. ©RSNA, 2022 Online supplemental material is available for this article.
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Affiliation(s)
- Arzu Canan
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Daniel Ocazionez-Trujillo
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Daniel Vargas
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Thomas A Foley
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Allison K Cabalka
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
| | - Prabhakar Shantha Rajiah
- From the Department of Radiology, UT Southwestern Medical Center, Dallas, Tex (A.C.); Department of Radiology, UT Health Sciences Center, Houston, Tex (D.O.T.); Department of Radiology, University of Colorado, Aurora, Colo (D.V.); and Department of Radiology (T.A.F., P.S.R.) and Division of Cardiology (A.K.C.), Mayo Clinic, 200 First St SW, Rochester, MN 55905
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15
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Kenny D, Hijazi ZM. Transcatheter Pulmonary Valve Replacement. Interv Cardiol 2022. [DOI: 10.1002/9781119697367.ch67] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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16
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Transcatheter Device Therapy and the Integration of Advanced Imaging in Congenital Heart Disease. CHILDREN 2022; 9:children9040497. [PMID: 35455541 PMCID: PMC9032030 DOI: 10.3390/children9040497] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/01/2022] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 01/04/2023]
Abstract
Transcatheter device intervention is now offered as first line therapy for many congenital heart defects (CHD) which were traditionally treated with cardiac surgery. While off-label use of devices is common and appropriate, a growing number of devices are now specifically designed and approved for use in CHD. Advanced imaging is now an integral part of interventional procedures including pre-procedure planning, intra-procedural guidance, and post-procedure monitoring. There is robust societal and industrial support for research and development of CHD-specific devices, and the regulatory framework at the national and international level is patient friendly. It is against this backdrop that we review transcatheter implantable devices for CHD, the role and integration of advanced imaging, and explore the current regulatory framework for device approval.
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Shorofsky MJ, Zablah JE, O'Callaghan B, Morgan GJ. Simultaneous deployment of a covered stent and a Sapien S3 as a bridge to surgical valve replacement in acute infective endocarditis. J Cardiol Cases 2022; 25:229-233. [DOI: 10.1016/j.jccase.2021.10.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2021] [Revised: 09/13/2021] [Accepted: 10/01/2021] [Indexed: 10/19/2022] Open
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Stammnitz C, Huscher D, Bauer UMM, Urban A, Nordmeyer J, Schubert S, Photiadis J, Berger F, Klaassen S. Nationwide Registry-Based Analysis of Infective Endocarditis Risk After Pulmonary Valve Replacement. J Am Heart Assoc 2022; 11:e022231. [PMID: 35179045 PMCID: PMC9075093 DOI: 10.1161/jaha.121.022231] [Citation(s) in RCA: 2] [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: 11/16/2022]
Abstract
Background Infective endocarditis (IE) after pulmonary valve replacements in congenital heart disease is a significant concern. This study aimed to identify specific long-term risk factors for IE after percutaneous pulmonary valve implantation or surgical pulmonary valve replacement. Methods and Results All patients with congenital heart disease from the National Register for Congenital Heart Defects with at least 1 pulmonary valve replacement before January 2018 were included. A total of 1170 patients (56.3% men, median age at study inclusion 12 [interquartile range {Q1-Q3} 5-20 years]) received 1598 pulmonary valve replacements. IE occurred in 4.8% of patients during a follow-up of total 9397 patient-years (median 10 [Q1-Q3, 6-10] years per patient). After homograft implantation 7 of 558 (1.3%) patients developed IE, after heterograft implantation 31 of 723 (4.3%) patients, and after Melody valve implantation 18 of 241 (7.5%) patients. Edwards Sapien and mechanical valves were used less frequently and remained without IE. The incidence of IE in heterografts excluding Contegra valves was 7 of 278 (2.5%), whereas the incidence of IE in Contegra valves was 24 of 445 (5.4%). The risk of IE was not increased compared with homografts if Contegra valves were excluded from the heterografts (hazard ratio [HR], 2.60; P=0.075). The risk of IE was increased for bovine jugular vein valves, Contegra valves (HR, 6.72; P<0.001), and Melody valves (HR, 5.49; P<0.001), but did not differ between Melody valves and Contegra valves (HR, 1.01; P=0.978). Conclusions Bovine jugular vein valves have the highest risk of IE, irrespective of the mode of deployment, either surgical or percutaneous.
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Affiliation(s)
- Clara Stammnitz
- Department of Pediatric Cardiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Competence Network for Congenital Heart Defects National Register for Congenital Heart Defects Berlin Germany
| | - Dörte Huscher
- Institute of Biometry and Clinical Epidemiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
| | - Ulrike M M Bauer
- Competence Network for Congenital Heart Defects National Register for Congenital Heart Defects Berlin Germany.,DZHK (German Centre for Cardiovascular Research) Berlin Germany
| | - Aleksandra Urban
- Competence Network for Congenital Heart Defects National Register for Congenital Heart Defects Berlin Germany
| | - Johannes Nordmeyer
- Department of Congenital Heart Disease - Pediatric Cardiology German Heart Center Berlin Berlin Germany
| | - Stephan Schubert
- Department of Congenital Heart Disease - Pediatric Cardiology German Heart Center Berlin Berlin Germany.,Center for Congenital Heart Disease/Pediatric Cardiology Heart- and Diabetes Center NRW University Clinic of Ruhr-University Bochum Bad Oeynhausen Germany
| | - Joachim Photiadis
- Department of Congenital Heart Surgery - Pediatric Heart Surgery German Heart Center Berlin Berlin Germany
| | - Felix Berger
- Department of Pediatric Cardiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,Department of Congenital Heart Disease - Pediatric Cardiology German Heart Center Berlin Berlin Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany
| | - Sabine Klaassen
- Department of Pediatric Cardiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.,DZHK (German Centre for Cardiovascular Research), partner site Berlin Berlin Germany.,Experimental and Clinical Research Center (ECRC), a cooperation between the Max-Delbrück-Center for Molecular Medicine in the Helmholtz Association and the Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany
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COVID-19 infection with delayed presentation of infective endocarditis of the prosthetic pulmonary valve. Cardiol Young 2021; 31:2045-2047. [PMID: 34092265 DOI: 10.1017/s1047951121002080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Pulmonary valve endocarditis after transcatheter pulmonary valve implantation has been an emerging concern due to the increasing prevalence of transcatheter placement of pulmonary valve in the treatment of residual right ventricular outflow tract stenosis or regurgitation. Pulmonary valve endocarditis is a dreadful complication of transcatheter pulmonary valve implantation that have been reported with Melody valve (Medtronic, Inc., Minneapolis, MN) and Edward Sapien valve (Edwards Life Sciences, Irvine, CA) till date. There are scanty available literatures for pulmonary valve endocarditis with Venus P valve (Venus Medtech, Hangzhou, China) implantation. Furthermore, cardiovascular comorbidity is common in COVID-19 infection with limited evidence of COVID-19 infection concomitant with infective endocarditis. This case happens to be the first reported case of infective endocarditis of pulmonary valve with concomitant COVID-19 infection and also delayed presentation of pulmonary valve endocarditis with Venus P valve implantation.
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20
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Aziz M, Sidhu R, Stinis CT. Transcatheter treatment of complex pulmonic and aortic valvular disease following failed Ross procedure. Clin Case Rep 2021; 9:e05172. [PMID: 34938551 PMCID: PMC8667297 DOI: 10.1002/ccr3.5172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 10/13/2021] [Accepted: 11/07/2021] [Indexed: 11/10/2022] Open
Abstract
A 63-year-old man with congenital bicuspid aortic valve disease and complex surgical history (that includes a Ross procedure complicated by cardiac arrest requiring emergency coronary artery bypass graft surgery, multiple subsequent sternotomies to treat a failed pulmonic homograft and pseudoaneurysm repair of the left and right ventricular outflow tracts (LVOT/RVOT), bioprosthetic aortic valve replacement, and aortic valve endocarditis) presented with worsening heart failure symptoms secondary to bioprosthetic aortic valve failure and recurrent pulmonic valve stenosis successfully treated with transcatheter intervention.
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Affiliation(s)
- Mohammad Aziz
- Department of Internal MedicineScripps ClinicLa JollaCaliforniaUSA
| | - Rajbir Sidhu
- Department of Cardiovascular DiseasesScripps ClinicLa JollaCaliforniaUSA
| | - Curtiss T. Stinis
- Department of Cardiovascular DiseasesScripps ClinicLa JollaCaliforniaUSA
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21
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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.
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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
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22
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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: 36] [Impact Index Per Article: 12.0] [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.
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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
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23
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Lourtet-Hascoet J, Hascoet S, Galinier JL, Fontenel B, Monteil B, Bonnet E. Endocarditis due to Gram Positive Anaerobic Cocci: First report of Peptoniphilus indolicus endocarditis and literature review. CLINICAL INFECTION IN PRACTICE 2021. [DOI: 10.1016/j.clinpr.2021.100073] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
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25
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Law MA, Chatterjee A. Transcatheter pulmonic valve implantation: Techniques, current roles, and future implications. World J Cardiol 2021; 13:117-129. [PMID: 34131475 PMCID: PMC8173335 DOI: 10.4330/wjc.v13.i5.117] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Revised: 03/11/2021] [Accepted: 04/21/2021] [Indexed: 02/06/2023] Open
Abstract
Right ventricular outflow tract (RVOT) obstruction is present in a variety of congenital heart disease states including tetralogy of Fallot, pulmonary atresia/stenosis and other conotruncal abnormalities etc. After surgical repair, these patients develop RVOT residual abnormalities of pulmonic stenosis and/or insufficiency of their native outflow tract or right ventricle to pulmonary artery conduit. There are also sequelae of other surgeries like the Ross operation for aortic valve disease that lead to right ventricle to pulmonary artery conduit dysfunction. Surgical pulmonic valve replacement (SPVR) has been the mainstay for these patients and is considered standard of care. Transcatheter pulmonic valve implantation (TPVI) was first reported in 2000 and has made strides as a comparable alternative to SPVR, being approved in the United States in 2010. We provide a comprehensive review in this space–indications for TPVI, detailed procedural facets and up-to-date review of the literature regarding outcomes of TPVI. TPVI has been shown to have favorable medium-term outcomes free of re-interventions especially after the adoption of the practice of pre-stenting the RVOT. Procedural mortality and complications are uncommon. With more experience, recognition of risk of dreaded outcomes like coronary compression has improved. Also, conduit rupture is increasingly being managed with transcatheter tools. Questions over endocarditis risk still prevail in the TPVI population. Head-to-head comparisons to SPVR are still limited but available data suggests equivalence. We also discuss newer valve technologies that have limited data currently and may have more applicability for treatment of native dysfunctional RVOT substrates.
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Affiliation(s)
- Mark Aaron Law
- Department of Pediatric Cardiology, Division of Cardiology, University of Alabama at Birmingham, Birmingham, AL 35233, United States
| | - Arka Chatterjee
- Division of Cardiology, University of Arizona College of Medicine, Tuscon, AZ 85724, United States
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26
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Revels JW, Wang SS, Gharai LR, Febbo J, Fadl S, Bastawrous S. The role of CT in planning percutaneous structural heart interventions: Where to measure and why. Clin Imaging 2021; 76:247-264. [PMID: 33991744 DOI: 10.1016/j.clinimag.2021.04.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 04/05/2021] [Accepted: 04/12/2021] [Indexed: 11/18/2022]
Abstract
As research continues to demonstrate successes in the use of percutaneous trans-vascular techniques in structural heart intervention, both the subspecialty trained and non-subspecialty trained cardiac imager find themselves performing and reporting larger amounts of information regarding cardiovascular findings. It is therefore imperative that the imager gains understanding and appreciation for how these various measurements are obtained, as well as their implication in a patient's care. Cardiac gated computed tomography (CT) has solidified its role and ability at providing high resolution images that can be used to obtain the key measurements used in structural heart intervention planning. This manuscript aims to provide an overview of what measurements are necessary to report when interpreting CT examinations purposed for structural heart intervention. This includes a review on indications and brief discussion on complications related to these procedures.
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Affiliation(s)
- Jonathan W Revels
- Department of Radiology, University of New Mexico, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131, USA. https://twitter.com/JRevRad1
| | - Sherry S Wang
- Department of Radiology and Imaging Sciences, University of Utah, 30 North 1900 East #1A71, Salt Lake City, UT 84132, USA. https://twitter.com/drsherrywang
| | - Leila R Gharai
- Department of Radiology, Virginia Commonwealth University, West Hospital, 1200 East Broad Street, North Wing, Room 2-013, Box 980470, Richmond, VA 23298-0470, USA
| | - Jennifer Febbo
- Department of Radiology, University of New Mexico, MSC 10 5530, 1 University of New Mexico, Albuquerque, NM 87131, USA. https://twitter.com/JennFebb
| | - Shaimaa Fadl
- Department of Radiology, Virginia Commonwealth University, West Hospital, 1200 East Broad Street, North Wing, Room 2-013, Box 980470, Richmond, VA 23298-0470, USA
| | - Sarah Bastawrous
- Department of Radiology, University of Washington, Puget Sound Veterans Administration Hospital, 1959 NE Pacific Street, Room BB308, Box 357115, Seattle, WA 98195, USA. https://twitter.com/sbastawrous1
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Virulence of clinically relevant multidrug resistant Corynebacterium striatum strains and their ability to adhere to human epithelial cells and inert surfaces. Microb Pathog 2021; 155:104887. [PMID: 33894290 DOI: 10.1016/j.micpath.2021.104887] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2021] [Revised: 04/07/2021] [Accepted: 04/08/2021] [Indexed: 01/13/2023]
Abstract
Corynebacterium striatum is a nosocomial pathogen which is increasingly associated with serious infections in both immunocompetent and immunocompromised patients. However, little is known about virulence factors and mechanisms that may enhance the establishment and long-term survival of Corynebacterium striatum. in the hospital environment. In this study, we investigated the ability of 22 multidrug-resistant C. striatum clinical isolates to adhere to human epithelial cells and to produce biofilm on polystyrene plates, glass and various tracheostomy tubes. We also tested the virulence of these strains on the nematode Caenorhabditis elegans. They showed good adhesion to epithelial human cells after 180 min of infection. The 22 C. striatum were able to produce biofilms on positively and negatively charged abiotic surfaces at 37 °C. They were also able to infect and to kill Caenorhabditis elegans after 5 days of infection. The virulence condition was associated with the presence of SpaDEF operon encoding pili in all strains. This study provides new insights on virulence mechanisms that may contribute to the persistence of C. striatum in the hospital environment, increasing the probability of causing nosocomial infections.
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28
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Khan D, Shadi M, Mustafa A, Karam B, Munir AB, Lafferty J, Glaser A, Mobarakai N. A Wolf in Sheep's clothing; Case reports and literature review of Corynebacterium striatum endocarditis. IDCases 2021; 24:e01070. [PMID: 33786323 PMCID: PMC7988320 DOI: 10.1016/j.idcr.2021.e01070] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 01/04/2021] [Accepted: 03/09/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- Danyal Khan
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, 10305, NY, USA
| | - Mahmoud Shadi
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, 10305, NY, USA
| | - Ahmad Mustafa
- Department of Internal Medicine, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, 10305, NY, USA
| | - Boutros Karam
- Department of Cardiology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, 10305, NY, USA
| | - Abdullah B Munir
- Department of Cardiology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, 10305, NY, USA
| | - James Lafferty
- Department of Cardiology, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, 10305, NY, USA
| | - Allison Glaser
- Department of Infectious Disease, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, 10305, NY, USA
| | - Neville Mobarakai
- Department of Infectious Disease, Staten Island University Hospital, 475 Seaview Avenue, Staten Island, 10305, NY, USA
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29
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Evaluation and Management of Pulmonic Valve Disease. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2021. [DOI: 10.1007/s11936-021-00897-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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30
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Taskesen T, Gill EA. Pulmonary valve assessment by three-dimensional echocardiography. Echocardiography 2021; 39:1001-1009. [PMID: 33604936 DOI: 10.1111/echo.15001] [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: 01/08/2021] [Revised: 01/24/2021] [Accepted: 01/29/2021] [Indexed: 11/29/2022] Open
Abstract
The pulmonary valve (PV) has historically been ignored by imaging studies. Disorders of the PV encountered in adult cardiac patients are increasingly encountered due to advanced care of patients with congenital heart disease and associated PV diseases. Despite advances in PV imaging, multiple challenges remain when it comes to obtaining high quality PV images. While 2D TTE is the usual initial imaging tool for PV, excellent views of the PV annulus and its one or two leaflets are obtained in less than half of patients. The 3D echocardiography en face view allows all three leaflets to be evaluated concurrently, as well as assessments of the RV outflow tract and main pulmonary artery, which has improved quantitative assessment of PV diseases. Increasing image quality and experience with live/real time 3D TEE amplifies its utility in accurate evaluation and helps guide and monitor successful percutaneous PV interventions. 2D TTE remains the first line diagnostic tool; however, 3D TTE and 3D TEE provide better image quality which increases diagnostic accuracy and guidance to therapy. In this review article, we stress improvement in 3D echocardiography and its role in diagnostic and therapeutic options for PV diseases.
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Affiliation(s)
- Tuncay Taskesen
- Division of Cardiology, MercyOne-Iowa Heart Center, Des Moines, IA, USA
| | - Edward A Gill
- Division of Cardiology, University of Colorado School of Medicine, Aurora, CO, USA
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31
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Qian T, Wu ZS, Hu JG, Yang YF, Wu Q, Lu T, Huang C, Li J. Midterm Outcomes of Crosslinked Acellular Bovine Jugular Vein Conduit for Right Ventricular Outflow Tract Reconstruction. Front Pediatr 2021; 9:725030. [PMID: 34485205 PMCID: PMC8416030 DOI: 10.3389/fped.2021.725030] [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] [Received: 06/14/2021] [Accepted: 07/23/2021] [Indexed: 11/13/2022] Open
Abstract
Objectives: Conduits for reconstructing right ventricular outflow tract (RVOT) in children with congenital heart disease have evolved for better durability over the past decades, but conduits failure remains common. We designed decellularized and photooxidatively crosslinked bovine jugular vein conduit (DP-BJVC) and now aim to evaluate the midterm results of DP-BJVC for RVOT reconstruction. Methods: Ninety patients (median age: 4.2 years) undergoing RVOT reconstruction using DP-BJVC were prospectively followed for median of 4.7 years (range: 0.2-16.1 years). Kaplan-Meier analysis was used to examine the survival, freedom from conduit explantation and catheter-based reintervention. Risk factors were analyzed with Cox regression analysis. Results: Follow-up was completed in 92% of patients. There were five (5.6%) early deaths. The 10-year survival rate was 85.2%, with palliative procedure at DP-BJVC implantation as the risk factor. The 10-year freedom from conduit explantation and reintervention were 84.4 and 67.3% respectively, with previous cardiac operation as the only risk factor for explantation. Complications during the follow-up included conduit stenosis (peak gradient ≥50 mmHg) in 12 (12.9%), severe regurgitation in 2 (2.4%), and infective endocarditis in 2 (2.4%). The annual increase in gradient was highest in the first year (P = 0.003), but not appreciably afterwards. The echo-measured annulus diameter trends to increase by an average of 0.37 mm per year. Calcification appeared mild in the failed conduits. Conclusions: DP-BJVC provides satisfactory durability and functionality for RVOT reconstruction for children, with low morbidity of stenosis and endocarditis, as well as increase in diameter mildly with age in midterm follow-ups.
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Affiliation(s)
- Tao Qian
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Zhong-Shi Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Jian-Guo Hu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Yi-Feng Yang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Qin Wu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China
| | - Ting Lu
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Can Huang
- Department of Cardiovascular Surgery, The Second Xiangya Hospital, Central South University, Changsha, China.,Engineering Laboratory of Hunan Province for Cardiovascular Biomaterials, Changsha, China
| | - Jia Li
- Clinical Physiology Laboratory, Guangzhou Women and Children's Medical Center, Institute of Pediatrics, Guangzhou Medical University, Guangzhou, China.,Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease, Guangzhou Women and Children's Medical Center, Guangzhou Medical University, Guangzhou, China
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32
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Kuang D, Lei Y, Yang L, Wang Y. Preclinical study of a self-expanding pulmonary valve for the treatment of pulmonary valve disease. Regen Biomater 2020; 7:609-618. [PMID: 33365146 PMCID: PMC7748448 DOI: 10.1093/rb/rbaa035] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Revised: 07/06/2020] [Accepted: 07/07/2020] [Indexed: 12/15/2022] Open
Abstract
In the past decade, balloon-expandable percutaneous pulmonary valves have been developed and applied in clinical practice. However, all the existing products of pulmonary artery interventional valves in the market have a straight structure design, and they require a preset support frame and balloon expansion. This shape design of the valve limits the application range. In addition, the age of the population with pulmonary artery disease is generally low, and the existing products cannot meet the needs of anti-calcification properties and valve material durability. In this study, through optimization of the support frame and leaflet design, a self-expanding pulmonary valve product with a double bell-shaped frame was designed to improve the match of the valve and the implantation site. A loading and deployment study showed that the biomaterial of the valve was not damaged after being compressed. Pulsatile flow and fatigue in vitro tests showed that the fabricated pulmonary valve met the hydrodynamic requirements after 2 × 108 accelerated fatigue cycles. The safety and efficacy of the pulmonary valve product were demonstrated in studies of pulmonary valve implantation in 11 pigs. Angiography and echocardiography showed that the pulmonary valves were implanted in a good position, and they had normal closure and acceptable valvular regurgitation. The 180 days' implantation results showed that the calcium content was 0.31-1.39 mg/g in the anti-calcification treatment group, which was significantly lower than that in the control valve without anti-calcification treatment (16.69 mg/g). Our new interventional pulmonary valve product was ready for clinical trials and product registration.
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Affiliation(s)
- Dajun Kuang
- National Engineering Research Center for Biomaterials, Sichuan University, No 29 Wangjiang Road, Chengdu 610064, China.,Venus Medtech (Hangzhou) Inc., 88 Jiangling Road, Hangzhou 311053, China
| | - Yang Lei
- National Engineering Research Center for Biomaterials, Sichuan University, No 29 Wangjiang Road, Chengdu 610064, China
| | - Li Yang
- National Engineering Research Center for Biomaterials, Sichuan University, No 29 Wangjiang Road, Chengdu 610064, China
| | - Yunbing Wang
- National Engineering Research Center for Biomaterials, Sichuan University, No 29 Wangjiang Road, Chengdu 610064, China
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33
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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.
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Affiliation(s)
- Doff B McElhinney
- Departments of Cardiothoracic Surgery and Pediatrics (Cardiology), Stanford University School of Medicine, Palo Alto, CA, USA
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34
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Noshak MA, Rezaee MA, Hasani A, Mirzaii M. The Role of the Coagulase-negative Staphylococci (CoNS) in Infective Endocarditis; A Narrative Review from 2000 to 2020. Curr Pharm Biotechnol 2020; 21:1140-1153. [PMID: 32324510 DOI: 10.2174/1389201021666200423110359] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2020] [Revised: 03/12/2020] [Accepted: 04/02/2020] [Indexed: 12/15/2022]
Abstract
Coagulase-negative staphylococci (CoNS) are part of the microbiota of human skin and rarely linked with soft tissue infections. In recent years, CoNS species considered as one of the major nosocomial pathogens and can cause several infections such as catheter-acquired sepsis, skin infection, urinary tract infection, endophthalmitis, central nervous system shunt infection, surgical site infections, and foreign body infection. These microorganisms have a significant impact on human life and health and, as typical opportunists, cause peritonitis in individuals undergoing peritoneal dialysis. Moreover, it is revealed that these potential pathogens are mainly related to the use of indwelling or implanted in a foreign body and cause infective endocarditis (both native valve endocarditis and prosthetic valve endocarditis) in patients. In general, approximately eight percent of all cases of native valve endocarditis is associated with CoNS species, and these organisms cause death in 25% of all native valve endocarditis cases. Moreover, it is revealed that methicillin-resistant CoNS species cause 60 % of all prosthetic valve endocarditis cases. In this review, we describe the role of the CoNS species in infective endocarditis, and we explicated the reported cases of CoNS infective endocarditis in the literature from 2000 to 2020 to determine the role of CoNS in the process of infective endocarditis.
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Affiliation(s)
- Mohammad A Noshak
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Student Research Committee, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mohammad A Rezaee
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Alka Hasani
- Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran,Department of Medical Microbiology, Faculty of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran
| | - Mehdi Mirzaii
- Department of Microbiology, School of Medicine, Shahroud University of Medical Sciences, Shahroud, Iran
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35
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Ge Y, Lu J, Feng S, Ji W, Tong H. A case of catheter related bloodstream infection by Corynebacterium striatum. IDCases 2020; 22:e00987. [PMID: 33194547 PMCID: PMC7644921 DOI: 10.1016/j.idcr.2020.e00987] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Revised: 10/09/2020] [Accepted: 10/10/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND C. striatum is an innocuous inhabitant of the normal human epithelial and mucosal surfaces. The C. striatum ´s thogenic potential is increasingly recognized in our time. METHODS We present a rare case of CRBSI by C. striatum in a 57-yr-old male patient. The patient suffered from many basic diseases and was admitted to hospital of shock. RESULTS The patient finally died of septic shock caused by CRBSI due to multidrug-resistant C. striatum which responded neither to empiric nor to targeted treatment. CONCLUSIONS C. striatum can cause CRBSI in immunocompromised patients when they were treated by intravenous catheters.
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Affiliation(s)
- Yanmei Ge
- Nanjing Tongren Hospital Affiliated to Medical School of Southeast University, Nanjing 211102, China
| | - Jingchuan Lu
- Nanjing Tongren Hospital Affiliated to Medical School of Southeast University, Nanjing 211102, China
| | - Shaozun Feng
- Nanjing Tongren Hospital Affiliated to Medical School of Southeast University, Nanjing 211102, China
| | - Wenli Ji
- Nanjing Tongren Hospital Affiliated to Medical School of Southeast University, Nanjing 211102, China
| | - Huacheng Tong
- Nanjing Tongren Hospital Affiliated to Medical School of Southeast University, Nanjing 211102, China
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36
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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.
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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,.
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37
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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.
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38
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Feins EN, Chávez M, Callahan R, Del Nido PJ, Emani SM, Baird CW. Experience and Outcomes of Surgically Implanted Melody Valve in the Pulmonary Position. Ann Thorac Surg 2020; 111:966-972. [PMID: 32603706 DOI: 10.1016/j.athoracsur.2020.05.061] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2020] [Revised: 04/25/2020] [Accepted: 05/07/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Multiple congenital cardiac malformations require pulmonary valve replacement and/or right ventricular outflow (RVOT) reconstruction. Pulmonary valve replacement remains challenging in children owing to the limited growth potential of prosthetic valves. We evaluated outcomes in patients undergoing surgical implantation of a Melody valve in the RVOT. METHODS Data were retrospectively collected for 23 patients undergoing surgical Melody valve implantation at Boston Children's Hospital between 2009 and 2019. We assessed postoperative valve function, reintervention rates, and mortality. RESULTS Median age was 1.7 years (range, 2 months to 6 years); 12 patients were aged greater than 2 years (52%). Diagnosis was tetralogy of Fallot in 15 patients (65%); 15 had a prior RVOT operation (65%). The Melody valve was dilated before surgery to a median diameter of 14 mm (range, 10-20 mm). No patients had acute pulmonary regurgitation. One required transcatheter RVOT reintervention before discharge. Median follow-up was 3.7 years (range, 0.02-8.7 years) with moderate or greater pulmonary regurgitation in 2 patients. Catheter-based interventions (mean, 0.83 ± 1.07/patient) occurred at a median of 1 year (range, 16 days to 5.4 years) and included valve expansion for somatic growth (n = 10) and subsequent valve-in-valve replacement (n = 3). Three patients (13%) required surgical valve explant or replacement at a median of 1.0 year (range, 0.6-3.7 years) for Melody-specific indications. One-, 3-, and 5-year freedom from Melody-driven reoperation was 90%, 90%, and 83%, respectively. CONCLUSIONS The Melody valve can be surgically implanted in the RVOT of young patients with acceptable early results. These valves can be successfully dilated through transcatheter reintervention to accommodate growth.
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Affiliation(s)
- Eric N Feins
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts.
| | - Mariana Chávez
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Ryan Callahan
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Pedro J Del Nido
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Sitaram M Emani
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Christopher W Baird
- Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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39
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Myadam R, DeZorzi C, Schmidt L, Lin P, McGhie AI. Melody Valve Endocarditis Due to Rothia dentocariosa: A Diagnostic Challenge. Cureus 2020; 12:e8840. [PMID: 32754384 PMCID: PMC7386052 DOI: 10.7759/cureus.8840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
Recently, there have been several advances in the field of adult congenital heart disease, such as the percutaneous pulmonic valve implantation (PPVI) to treat right ventricular outflow obstruction. Complications from this technique are seldom but essential to understand. We present a case of a 37-year-old Caucasian male with complicated congenital heart disease, including prior Melody valve implantation, who presented to our hospital with recurrent episodes of pneumonia of two months duration. He was diagnosed with prosthetic valve endocarditis (PVE) from an unusual organism, Rothia dentocariosa. He eventually underwent surgical replacement of the infected valve. Our report is the first case of Melody valve endocarditis due to Rothia dentocariosa reported from the United States.
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Affiliation(s)
- Rahul Myadam
- Internal Medicine, University of Missouri-Kansas City, Kansas City, USA
| | - Christopher DeZorzi
- Cardiology, University of Missouri-Kansas City School of Medicine, Kansas City, USA
| | - Laura Schmidt
- Cardiology, Saint Luke's Mid America Heart Institute, Kansas City, USA
| | - Peter Lin
- Pathology, Mayo Clinic, Rochester, USA
| | - Arthur I McGhie
- Cardiology, Saint Luke's Mid-America Heart Institute, Kansas City, USA
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40
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IJsselhof RJ, Slieker MG, Gauvreau K, Muter A, Marx GR, Hazekamp MG, Accord R, van Wetten H, van Leeuwen W, Haas F, Schoof PH, Nathan M. Mechanical Mitral Valve Replacement: A Multicenter Study of Outcomes With Use of 15- to 17-mm Prostheses. Ann Thorac Surg 2020; 110:2062-2069. [PMID: 32525029 DOI: 10.1016/j.athoracsur.2020.04.084] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2020] [Revised: 04/15/2020] [Accepted: 04/16/2020] [Indexed: 12/17/2022]
Abstract
BACKGROUND The aim of this study was to evaluate early and mid-term outcomes (mortality and prosthetic valve reintervention) after mitral valve replacement with 15- to 17-mm mechanical prostheses. METHODS A multicenter, retrospective cohort study was performed among patients who underwent mitral valve replacement with a 15- to 17-mm mechanical prosthesis at 6 congenital cardiac centers: 5 in The Netherlands and 1 in the United States. Baseline, operative, and follow-up data were evaluated. RESULTS Mitral valve replacement was performed in 61 infants (15 mm, n = 17 [28%]; 16 mm, n = 18 [29%]; 17 mm, n = 26 [43%]), of whom 27 (47%) were admitted to the intensive care unit before surgery and 22 (39%) required ventilator support. Median age at surgery was 5.9 months (interquartile range [IQR] 3.2-17.4), and median weight was 5.7 kg (IQR, 4.5-8.8). There were 13 in-hospital deaths (21%) and 8 late deaths (17%, among 48 hospital survivors). Major adverse events occurred in 34 (56%). Median follow-up was 4.0 years (IQR, 0.4-12.5) First prosthetic valve replacement (n = 27 [44%]) occurred at a median of 3.7 years (IQR, 1.9-6.8). Prosthetic valve endocarditis was not reported, and there was no mortality related to prosthesis replacement. Other reinterventions included permanent pacemaker implantation (n = 9 [15%]), subaortic stenosis resection (n = 4 [7%]), aortic valve repair (n = 3 [5%], and aortic valve replacement (n = 6 [10%]). CONCLUSIONS Mitral valve replacement with 15- to 17-mm mechanical prostheses is an important alternative to save critically ill neonates and infants in whom the mitral valve cannot be repaired. Prosthesis replacement for outgrowth can be carried out with low risk.
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Affiliation(s)
- Rinske J IJsselhof
- Department of Pediatric Cardiac Surgery, University Medical Center Utrecht, Utrecht, the Netherlands.
| | - Martijn G Slieker
- Department of Pediatric Cardiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Angelika Muter
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts
| | - Gerald R Marx
- Department of Cardiology, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Mark G Hazekamp
- Department of Cardiothoracic Surgery, Leiden University Medical Center, Leiden, The Netherlands
| | - Ryan Accord
- Department of Cardiothoracic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Herbert van Wetten
- Department of Cardiothoracic Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Wouter van Leeuwen
- Department of Cardiothoracic Surgery, Erasmus MC, Rotterdam, The Netherlands
| | - Felix Haas
- Department of Pediatric Cardiac Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Paul H Schoof
- Department of Pediatric Cardiac Surgery, University Medical Center Utrecht, Utrecht, the Netherlands
| | - Meena Nathan
- Department of Cardiac Surgery, Boston Children's Hospital, Boston, Massachusetts; Department of Cardiac Surgery, Boston Children's Hospital, Harvard Medical School, Boston, Massachusetts
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41
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Alkashkari W, Albugami S, Abbadi M, Niyazi A, Alsubei A, Hijazi ZM. Transcatheter pulmonary valve replacement in pediatric patients. Expert Rev Med Devices 2020; 17:541-554. [PMID: 32459512 DOI: 10.1080/17434440.2020.1775578] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
INTRODUCTION Right ventricular outflow tract (RVOT) dysfunction is common among individuals with congenital heart disease (CHD). Surgical intervention often carries prohibitive risks due to the need for sequential pulmonary valve (PV) replacements throughout their life in the majority of cases. Transcatheter pulmonary valve replacement (tPVR) is one of the most exciting recent developments in the treatment of CHD and has evolved to become an attractive alternative to surgery in patients with RVOT dysfunction. AREAS COVERED In this review, we examine the pathophysiology of RVOT dysfunction, indications for tPVR, and the procedural aspect. Advancements in clinical application and valve technology will also be covered. EXPERT OPINION tPVR is widely accepted as an alternative to surgery to address RVOT dysfunction, but still significant numbers of patients with complex RVOT morphology deemed not suitable for tPVR. As the technology continues to evolve, new percutaneous valves will allow such complex RVOT patient to benefit from tPVR.
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Affiliation(s)
- Wail Alkashkari
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Saad Albugami
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Mosa Abbadi
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Akram Niyazi
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Amani Alsubei
- Department of Cardiology, King Faisal Cardiac Center, Ministry of National Guard Health Affair , Jeddah, Saudi Arabia.,Medical Research Department, King Abdullah International Medical Research Center , Jeddah, Saudi Arabia.,Medical Research Department, King Saud Bin Abdulaziz University for Health Science , Jeddah, Saudi Arabia
| | - Ziyadi M Hijazi
- Sidra Heart Center, Sidra Medicine , Doha, Qatar.,Medical Research Department, Weill Cornell Medicine , New York, NY, USA
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42
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Souza CD, Mota HF, Faria YV, Cabral FDO, Oliveira DRD, Sant'Anna LDO, Nagao PE, Santos CDS, Moreira LO, Mattos-Guaraldi AL. Resistance to Antiseptics and Disinfectants of Planktonic and Biofilm-Associated Forms of Corynebacterium striatum. Microb Drug Resist 2020; 26:1546-1558. [PMID: 32429830 DOI: 10.1089/mdr.2019.0124] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Disinfection and antisepsis are of primary importance in controlling nosocomial infections and outbreaks by pathogens expressing multiple resistance to antimicrobial agents (multidrug-resistant [MDR]) used in therapy. Nowadays, infections related to health services (HAIs) due to MDR and multidrug-susceptible (MDS) Corynebacterium striatum should not be underestimated, including patients using invasive medical devices. The virulence potential of C. striatum needs further investigation. Currently, susceptibility profiles of planktonic and/or sessile forms of four C. striatum strains of different pulsed-field gel electrophoresis types were examined as biocides based on the manufacturer's recommendations: 2% glutaraldehyde (GA), 2% peracetic acid (PA), 1% potassium monopersulfate (Virkon®; VK), 1% sodium hypochlorite (SH), and 70% ethyl alcohol (ET). Time-kill assays using 2% bovine serum albumin (BSA) were performed for evaluation of influence of organic matter on biocides effects. Planktonic forms expressed GA resistance at different levels. C. striatum viability was observed until 2, 4, 20, and 30 min for MDR 2369/II, MDS 1954/IV, MDR 1987/I, and MDS 1961/III strains, respectively. In contrast to GA, the biocides PA, VK24h, SH, and ET had higher effective bacterial mortality. However, storage of VK (48 hr) reduced their biocide activities. Moreover, mature biofilms were produced on abiotic substrates, including steel surfaces. Post-treatment with GA (30 min), survival of sessile forms was ≥100% than planktonic forms of all C. striatum tested strains. Independent of biocides tested, BSA increased the survival of planktonic and sessile forms (p ≤ 0.005). Present data indicated that hospital staff should be aware of dissemination and eradication of HAIs by C. striatum presenting resistance to biocides, including high-level disinfectants, such as GA.
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Affiliation(s)
- Cassius de Souza
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance (LDCIC), Faculdade de Ciências Médicas (FCM), Universidade do Estado do Rio de Janeiro (UERJ), The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health-FNS/MS, Rio de Janeiro, Brazil
| | - Higor Franceschi Mota
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance (LDCIC), Faculdade de Ciências Médicas (FCM), Universidade do Estado do Rio de Janeiro (UERJ), The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health-FNS/MS, Rio de Janeiro, Brazil
| | - Yuri Vieira Faria
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance (LDCIC), Faculdade de Ciências Médicas (FCM), Universidade do Estado do Rio de Janeiro (UERJ), The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health-FNS/MS, Rio de Janeiro, Brazil
| | - Fellipe de Oliveira Cabral
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance (LDCIC), Faculdade de Ciências Médicas (FCM), Universidade do Estado do Rio de Janeiro (UERJ), The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health-FNS/MS, Rio de Janeiro, Brazil
| | - Dryelle Rodrigues de Oliveira
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance (LDCIC), Faculdade de Ciências Médicas (FCM), Universidade do Estado do Rio de Janeiro (UERJ), The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health-FNS/MS, Rio de Janeiro, Brazil
| | - Lincoln de Oliveira Sant'Anna
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance (LDCIC), Faculdade de Ciências Médicas (FCM), Universidade do Estado do Rio de Janeiro (UERJ), The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health-FNS/MS, Rio de Janeiro, Brazil
| | - Prescilla Emy Nagao
- Departamento de Biologia Celular, Instituto de Biologia Roberto Alcântara Gomes, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Cintia da Silva Santos
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance (LDCIC), Faculdade de Ciências Médicas (FCM), Universidade do Estado do Rio de Janeiro (UERJ), The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health-FNS/MS, Rio de Janeiro, Brazil
| | - Lílian Oliveira Moreira
- Faculdade de Farmácia, Universidade Federal do Rio de Janeiro (UFRJ), Rio de Janeiro, Brazil
| | - Ana Luíza Mattos-Guaraldi
- Laboratory of Diphtheria and Corynebacteria of Clinical Relevance (LDCIC), Faculdade de Ciências Médicas (FCM), Universidade do Estado do Rio de Janeiro (UERJ), The Collaborating Centre for Reference and Research on Diphtheria/National Health Foundation/Ministry of Health-FNS/MS, Rio de Janeiro, Brazil
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Ribeiro JM, Teixeira R, Lopes J, Costa M, Pires A, Gonçalves L. Transcatheter Versus Surgical Pulmonary Valve Replacement: A Systemic Review and Meta-Analysis. Ann Thorac Surg 2020; 110:1751-1761. [PMID: 32268142 DOI: 10.1016/j.athoracsur.2020.03.007] [Citation(s) in RCA: 22] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/25/2020] [Accepted: 03/02/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND Transcatheter pulmonary valve replacement (TPVR) has emerged as an alternative to surgery in patients with pulmonary valve dysfunction. METHODS We searched the Medline and Cochrane databases since their inception to January 2019 as well as references from article, for all publications comparing TPVR with surgical PVR (SPVR). Studies were considered for inclusion if they reported comparative data regarding any of the study endpoints. The primary endpoint was early mortality after PVR. Secondary endpoints included procedure-related complications, length of hospital stay, mortality during follow-up, infective endocarditis, need for reintervention, post-PVR transpulmonary peak systolic gradient, and significant pulmonary regurgitation. RESULTS There were no differences in perioperative mortality between groups (0.2% vs 1.2%; pooled odds ratio, 0.56; 95% confidence interval, 0.19-1.59; P = .27, I2 = 0%). However TPVR conferred a significant reduction in procedure-related complications and length of hospital stay compared with SPVR. Midterm mortality and the need for repeat intervention were similar with both techniques, but pooled infective endocarditis was significantly more frequent in the TPVR group (5.8 vs 2.7%; pooled odds ratio, 3.09; 95% confidence interval, 1.89-5.06; P < .001, I2 = 0%). TPVR was associated with less significant PR and a trend towards a lower transpulmonary systolic gradient during follow-up. CONCLUSIONS TPVR is a safe alternative to SPVR in selected patients and is associated with a shorter length of hospital stay and fewer procedure-related complications. At midterm follow-up TPVR was comparable with SPVR in terms of mortality and repeat intervention but was associated with an increased risk of infective endocarditis.
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Affiliation(s)
- Joana Maria Ribeiro
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal.
| | - Rogério Teixeira
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
| | - João Lopes
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Marco Costa
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - António Pires
- Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal; Serviço de Cardiologia Pediátrica, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal
| | - Lino Gonçalves
- Serviço de Cardiologia, Centro Hospitalar e Universitário de Coimbra, Coimbra, Portugal; Faculdade de Medicina da Universidade de Coimbra, Coimbra, Portugal
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Morgan GJ, Sivakumar K, Promphan W, Goreczny S, Prachasilchai P, Qureshi S. Early clinical experience with the straight design of Venus P-valve™ in dysfunctional right ventricular outflow tracts. Catheter Cardiovasc Interv 2020; 96:E653-E659. [PMID: 32096924 DOI: 10.1002/ccd.28819] [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: 03/20/2019] [Revised: 02/10/2020] [Accepted: 02/14/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVES To assess the initial procedural and short to medium-term experience with the straight design of the Venus P-valve™ (Venus MedTech, Hangzhou, China) in dysfunctional right ventricular outflow tracts (RVOT). BACKGROUND The Melody™ valve (Medtronic, Minneapolis, Minnesota) has been the only percutaneous valve option for smaller RVOT conduits. The straight Venus P-valve™ may provide an alternative to the Melody™ valve. METHODS Retrospective data collection of patient characteristics, procedural data, clinical and imaging follow-up of the straight Venus P-valve™. RESULTS Nine patients (four female) with a mean age of 23.1 ± 7.5 years and a mean weight of 72.7 ± 29.4 kg underwent straight Venus P-valve™ implantation between 03/2014 and 06/2016. All patients had right ventricle-to-pulmonary artery conduits which were pre-stented before the valve implantation. All valves were deployed successfully without any significant procedural complications. During the mean follow-up of 24 ± 9.1 months, there were no valve related re-interventions or deterioration in valve performance. There was one case of insignificant, single wire frame fracture and no cases of endocarditis. The cohort demonstrated a reduction in pulmonary regurgitation and tricuspid regurgitation, which was sustained throughout the follow-up. Similarly the gradient across the RVOT tract did not significantly increase. CONCLUSIONS Implantation of the straight Venus P-valve™ has provided satisfactory short to mid-term results with high success rates and no complications and may be considered as an alternative option in patients with RVOT dysfunction.
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Affiliation(s)
- Gareth J Morgan
- Department of Cardiology, Colorado Children's Hospital, University of Colorado Hospital, Denver, Colorado, USA.,Department of Adult Congenital Cardiology, University of Colorado Hospital, Denver, Colorado, USA.,Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Kothandam Sivakumar
- Department of Pediatric Cardiology, Institute of Cardiovascular Diseases, Madras Medical Mission, Chennai, India
| | - Worakan Promphan
- Pediatric Cardiac Center, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Sebastian Goreczny
- Department of Cardiology, Colorado Children's Hospital, University of Colorado Hospital, Denver, Colorado, USA.,Department of Cardiology, Polish Mother's Memorial Hospital, Research Institute, Lodz, Poland
| | - Pimpak Prachasilchai
- Pediatric Cardiac Center, Queen Sirikit National Institute of Child Health, College of Medicine, Rangsit University, Bangkok, Thailand
| | - Shakeel Qureshi
- Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
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45
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Ou-Yang WB, Qureshi S, Ge JB, Hu SS, Li SJ, Yang KM, Zhang GJ, Zhou DX, Chen M, Wang SZ, Zhang FW, Pan XB. Multicenter Comparison of Percutaneous and Surgical Pulmonary Valve Replacement in Large RVOT. Ann Thorac Surg 2020; 110:980-987. [PMID: 32087135 DOI: 10.1016/j.athoracsur.2020.01.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 12/12/2019] [Accepted: 01/02/2020] [Indexed: 02/05/2023]
Abstract
BACKGROUND A percutaneous approach for pulmonary valve replacement (PVR) is a feasible alternative to surgical PVR in selected patients with severe pulmonary regurgitation after repair of tetralogy of Fallot. However, large right ventricular outflow tract (diameter ≥ 25 mm) remains challenging. METHODS This retrospective multicenter study enrolled consecutive patients with large right ventricular outflow tract who underwent percutaneous PVR (Venus P-valve, Venus MedTech Inc, Hangzhou, China) (n = 35) or surgical PVR (homograft valve; n = 30) between May 2014 and April 2017. Patients were followed up at 1, 3, 6, and 12 months, and yearly thereafter. Main study outcomes were pulmonary valve function and right ventricular function at discharge and midterm follow-up. RESULTS PVR was successful in all patients. Percutaneous compared with surgical PVR group had: similarly distributed baseline characteristics; shorter hospitalization, intensive care unit stay, and endotracheal intubation duration; lower cost; lower pulmonary valve gradient before discharge; lower pulmonary valve regurgitant grade (mean difference, -0.63; 95% CI -1.11 to -0.20, P = .022), pulmonary valve gradient (mean difference, -5.7 mm Hg; 95% CI -9.4 to -2.2 mm Hg, P = .005), and right ventricular end-diastolic volume index (mean difference, -9.5 mL/m2; 95% CI -16.9 to -3.1 mL/m2, P = .022); and greater right ventricular ejection fraction (mean difference, 5.4%; 95% CI 2.4%-8.3%, P = .002) at median 36 months follow-up, without deaths in either group. CONCLUSIONS Percutaneous PVR using Venus P-valve appeared to be a safe, efficacious and minimally invasive alternative to surgical PVR in selected patients with large right ventricular outflow tract yielding better right ventricular and pulmonary valve function at midterm follow-up.
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Affiliation(s)
- Wen-Bin Ou-Yang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shakeel Qureshi
- Department of Paediatric Cardiology, Evelina London Children's Hospital, London, United Kingdom
| | - Jun-Bo Ge
- Department of Cardiology, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Sheng-Shou Hu
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Shou-Jun Li
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ke-Ming Yang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Ge-Jun Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Da-Xin Zhou
- Department of Cardiology, Shanghai Zhongshan Hospital, Fudan University, Shanghai, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, Sichuan, China
| | - Shou-Zheng Wang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Feng-Wen Zhang
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China
| | - Xiang-Bin Pan
- Department of Structural Heart Disease, National Center for Cardiovascular Disease, China & Fuwai Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Beijing, China.
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46
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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]
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47
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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.
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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
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Pluchinotta FR, Piekarski BL, Milani V, Kretschmar O, Burch PT, Hakami L, Meyer DB, Jacques F, Ghez O, Trezzi M, Carotti A, Qureshi SA, Michel-Behnke I, Hammel JM, Chai P, McMullan D, Mettler B, Ferrer Q, Carminati M, Emani SM. Surgical Atrioventricular Valve Replacement With Melody Valve in Infants and Children. Circ Cardiovasc Interv 2019; 11:e007145. [PMID: 30571200 DOI: 10.1161/circinterventions.118.007145] [Citation(s) in RCA: 47] [Impact Index Per Article: 9.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Pediatric patients with atrioventricular valve disease have limited options for prosthetic valve replacement in sizes <15 mm. Based on successful experience with the stented bovine jugular vein graft (Melody valve) in the right ventricular outflow tract, the prosthesis has been modified for surgical valve replacement in pediatric patients with atrioventricular dysfunction with the intention of subsequent valve expansion in the catheterization laboratory as the child grows. Methods and Results A multicenter, retrospective cohort study was performed among patients who underwent atrioventricular valve replacement with Melody valve at 17 participating sites from North America and Europe, including 68 patients with either mitral (n=59) or tricuspid (n=9) replacement at a median age of 8 months (range, 3 days to 13 years). The median size at implantation was 14 mm (range, 9-24 mm). Immediately postoperatively, the valve was competent with low gradients in all patients. Fifteen patients died; 3 patients underwent transplantation. Nineteen patients required reoperation for adverse outcomes, including valve explantation (n=16), left ventricular outflow tract obstruction (n=1), permanent pacemaker implantation (n=1), and paravalvular leak repair (n=1). Twenty-five patients underwent 41 episodes of catheter-based balloon expansion, exhibiting a significant decrease in median gradient ( P<0.001) with no significant increase in grade of regurgitation. Twelve months after implantation, cumulative incidence analysis indicated that 55% of the patients would be expected to be free from death, heart transplantation, structural valve deterioration, or valve replacement. Conclusions The Melody valve is a feasible option for surgical atrioventricular valve replacement in patients with hypoplastic annuli. The prosthesis shows acceptable short-term function and is amenable to catheter-based enlargement as the child grows. However, patients remain at risk for mortality and structural valve deterioration, despite adequate early valvular function. Device design and implantation techniques must be refined to reduce complications and extend durability. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02505074.
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Affiliation(s)
- Francesca R Pluchinotta
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy (F.R.P., M.C.)
| | | | - Valentina Milani
- Department of Cardiology and Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy (V.M., S.M.E.)
| | - Oliver Kretschmar
- Department of Pediatric Cardiology, University Children's Hospital Zurich, Switzerland (O.K.)
| | - Phillip T Burch
- Department of Cardiothoracic Surgery, Cook Children's Medical Center, Fort Worth, TX (P.T.B.)
| | - Lale Hakami
- Department of Heart Surgery, Medical Center of the University of Munich, Germany (L.H.)
| | - David B Meyer
- Division of Cardiothoracic Surgery, Cohen Children's Medical Center, New Hyde Park, NY (D.B.M.)
| | - Frederic Jacques
- Department of Cardiology and Cardiac Surgery, Centre mère-enfant Soleil, CHU de Québec, Service of Cardiac Surgery, Canada (F.J.)
| | - Olivier Ghez
- Department of Cardiac Surgery, Royal Brompton Hospital, London, England (O.G.)
| | - Matteo Trezzi
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy (M.T., A.C.)
| | - Adriano Carotti
- Department of Pediatric Cardiac Surgery, Bambino Gesù Children's Hospital Istituto di Ricovero e Cura a Carattere Scientifico, Rome, Italy (M.T., A.C.)
| | - Shakeel A Qureshi
- Department of Cardiology and Cardiac Surgery, Evelina London Children's Hospital, England (S.A.Q.)
| | - Ina Michel-Behnke
- Division of Pediatric Cardiology, Pediatric Heart Center Vienna, University Clinic for Pediatrics and Adolescent Medicine, Medical University of Vienna, Austria (I.M.-B.)
| | - James M Hammel
- Department of Cardiothoracic Surgery, Children's Hospital and Medical Center, Omaha, NE (J.M.H.)
| | - Paul Chai
- Department of Cardiac Surgery, New York-Presbyterian Morgan Stanley Children's Hospital (P.C.)
| | - David McMullan
- Department of Cardiac Surgery, Seattle Children's Hospital, WA (D.M.)
| | - Bret Mettler
- Division of Pediatric Cardiac Surgery, Vanderbilt University Medical Center, Nashville, TN (B.M.)
| | - Queralt Ferrer
- Department of Pediatric Cardiology and Pediatric Cardiac Surgery, University Hospital Vall d'Hebron, Barcelona, Spain (Q.F.)
| | - Mario Carminati
- Department of Pediatric Cardiology and Adult Congenital Heart Disease, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy (F.R.P., M.C.)
| | - Sitaram M Emani
- Department of Cardiology and Cardiac Surgery, Istituto di Ricovero e Cura a Carattere Scientifico Policlinico San Donato, Milan, Italy (V.M., S.M.E.)
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49
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Tan W, Dora A, Lluri G, Aboulhosn J. Candida Parapsilosis Endocarditis Following Transcatheter Pulmonary Valve Implantation. World J Pediatr Congenit Heart Surg 2019; 11:112-113. [PMID: 31658874 DOI: 10.1177/2150135119883624] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
Fungal prosthetic valve endocarditis (PVE) is rare and carries a high mortality rate. While uncommon, fungal endocarditis in transcatheter aortic valves has been reported. We present a unique case of Candida parapsilosis fungal PVE in a patient with a transcatheter pulmonary valve replacement.
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Affiliation(s)
- Weiyi Tan
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Amy Dora
- Division of Infectious Diseases, Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Gentian Lluri
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA
| | - Jamil Aboulhosn
- Division of Cardiology, Department of Medicine, UCLA Medical Center, Los Angeles, CA, USA
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50
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McElhinney DB, Sondergaard L, Armstrong AK, Bergersen L, Padera RF, Balzer DT, Lung TH, Berger F, Zahn EM, Gray RG, Hellenbrand WE, Kreutzer J, Eicken A, Jones TK, Ewert P. Endocarditis After Transcatheter Pulmonary Valve Replacement. J Am Coll Cardiol 2019; 72:2717-2728. [PMID: 30497557 DOI: 10.1016/j.jacc.2018.09.039] [Citation(s) in RCA: 86] [Impact Index Per Article: 17.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/25/2018] [Revised: 08/08/2018] [Accepted: 09/04/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Endocarditis has emerged as one of the most concerning adverse outcomes in patients with congenital anomalies involving the right ventricular outflow tract (RVOT) and prosthetic valves. OBJECTIVES The aim of this study was to evaluate rates and potential risk factors for endocarditis after transcatheter pulmonary valve replacement in the prospective Melody valve trials. METHODS All patients in whom a transcatheter pulmonary valve (TPV) was implanted in the RVOT as part of 3 prospective multicenter studies comprised the analytic cohort. The diagnosis of endocarditis and involvement of the TPV were determined by the implanting investigator. RESULTS A total of 309 patients underwent transcatheter pulmonary valve replacement (TPVR) and were discharged with a valve in place. The median follow-up duration was 5.1 years, and total observation until study exit was 1,660.3 patient-years. Endocarditis was diagnosed in 46 patients (median 3.1 years after TPVR), and a total of 35 patients were reported to have TPV-related endocarditis (34 at the initial diagnosis, 1 with a second episode). The annualized incidence rate of endocarditis was 3.1% per patient-year and of TPV-related endocarditis was 2.4% per patient-year. At 5 years post-TPVR, freedom from a diagnosis of endocarditis was 89% and freedom from TPV-related endocarditis was 92%. By multivariable analysis, age ≤12 years at implant (hazard ratio: 2.3; 95% confidence interval: 1.2 to 4.4; p = 0.011) and immediate post-implant peak gradient ≥15 mm Hg (2.7; 95% confidence interval: 1.4 to 4.9; p = 0.002) were associated with development of endocarditis and with development of TPV-related endocarditis (age ≤12 years: 2.8; 95% confidence interval: 1.3 to 5.7; p = 0.006; gradient ≥15 mm Hg: 2.6; 95% confidence interval: 1.3 to 5.2; p = 0.008). CONCLUSIONS Endocarditis is an important adverse outcome following TVPR in children and adults with post-operative congenital heart disease involving the RVOT. Ongoing efforts to understand, prevent, and optimize management of this complication are paramount in making the best use of TPV therapy. (Melody Transcatheter Pulmonary Valve [TPV] Study: Post Approval Study of the Original Investigational Device Exemption [IDE] Cohort; NCT00740870; Melody Transcatheter Pulmonary Valve Post-Approval Study; NCT01186692; and Melody Transcatheter Pulmonary Valve [TPV] Post-Market Surveillance Study; NCT00688571).
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Affiliation(s)
| | - Lars Sondergaard
- The Heart Center, Rigshospitalet, University of Copenhagen, Copenhagen, Denmark
| | | | | | - Robert F Padera
- Brigham and Women's Hospital, Children's Hospital Boston and Harvard Medical School, Boston, Massachusetts
| | | | | | | | - Evan M Zahn
- Cedars-Sinai Heart Institute, Los Angeles, California
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