Abstract 13084: Occurrence of Infective Endocarditis After Transcatheter versus Surgical Pulmonary Valve Implantation: Results of a Nationwide Administrative Database

Abstract

Background: It is unclear if the risk of infective endocarditis (IE) differs between transcatheter (TPVI) and surgical (SPVR) pulmonary valve implantation. We sought to address this question using administrative data including a large nationwide patient population. Methods: All congenital heart disease (CHD) patients ≥4 years of age who underwent isolated pulmonary valve implantation were identified in the BARMER Health Insurance Company database (≈9 million members, representative of the German population). Data from 01/2005 to 12/2018 were analyzed with regard to overall survival and complications particularly focusing on IE. Results: Overall, 461 pulmonary valve implantations were performed in 413 patients (59.4% male, median age 18.6 years (IQR 12.8-31.3)). Of those, 38.4% (n=177) underwent TPVI, while 61.6% (n=284) were treated with SPVR. Overall, IE was diagnosed in 8.0% (n=37) of cases after a median of 1.3 years (IQR 0.2-3.7). In the TPVI cohort, IE occurred in 10.2% (n=18) of cases, while IE was diagnosed in 6.7% (n=19) of cases with SPVR ( p =0.217). Furthermore, 5.0% (n=23) of all patients died during follow-up (of those n=4 within 90 days after diagnosis of IE). On multivariable Cox-regression analysis, previous diagnosis of IE was associated with a higher risk of re-IE ( p =0.025), but no association between IE and age ( p =0.17), sex ( p =0.34) or type of CHD was found ( p =0.71). While the overall rate of IE was not dependent on the treatment modality, there were significant time-dependent differences: Within the first year of follow-up, freedom from IE or death was significantly higher in the TPVI cohort (HR 5.26 [95% CI 1.59-16.67], p =0.006) compared to SPVR), but within the 3-10 year period the probability reversed in favor of the SPVR cohort (HR 10.07 [95% CI 3.41-29.76], p <0.001) compared to TPVI). Conclusion: In a cohort of 413 patients undergoing pulmonary valve implantation, infective endocarditis occurred in 8.0% of cases. The overall rate of infective endocarditis was not significantly different between surgical and interventional pulmonary valve procedures. However, while early endocarditis was more often related to surgical procedures, the mid-term IE risk was significantly lower in surgically treated patients.