0489: Incidence and outcomes of right sided endocarditis in patients with congenital heart diseases with surgical or transcatheter pulmonary valve implantation

Abstract

To evaluate and compare the incidence, clinical presentations and outcomes of right-sided infective endocarditis in patients with surgical pulmonary conduit versus those with percutaneous pulmonary valve implantation. All consecutive patients who received a pulmonary valve surgically or percutaneously between January 2009 and June 2013 were included and evaluated for endocarditis. Of the 195 conduits surgically implanted (surgical group) and 93 Melody valves percutaneously implanted (PPVI group), the person-time incidence rates of endocarditis were 1.2 and 3.9 cases per 100 person-years in the surgical and PPVI groups respectively (p=0.03). Clinical presentations, microbiology and outcomes were comparable in both groups. The implantationendocarditis time interval was much shorter in the Melody valve patients (p=0.0065). On multivariate analysis, only a past history of endocarditis was found to significantly correlate with endocarditis (p=0.004). Probability of survival at 12, 24 and 36 months was 99.5%, 93.8%, 93.8% in the surgical-group and 98.9%, 96.8%, 92.3% in the Melody-group respectively (p=0.6). Event free probability including endocarditis was comparable (p=0.1). There is a high person-time incidence of endocarditis in patients with Melody valve when compared to surgically implanted pulmonary valves. Clinical features and microbiology were comparable in both groups. The possible role of the bovine jugular vein in the development of endocarditis is concerning. However, despite a higher incidence of Melody valve endocarditis, probabilities of survival and event free survival were similar to the surgical group.