Incidence and outcomes of right-sided endocarditis in patients with congenital heart disease after surgical or transcatheter pulmonary valve implantation

Abstract

To evaluate right-sided endocarditis and compare the incidence, clinical presentations, and outcomes in patients with a surgical and percutaneous pulmonary valve. All patients with infective endocarditis occurring between January 2009 and June 2013 were identified and studied. All consecutive patients who received a pulmonary valve surgically or by percutaneous pulmonary valve implantation (PPVI) during the same period were also evaluated for endocarditis. During the study period, 31 patients were identified with right-sided endocarditis: 13 had valves implanted during the study period and 18 before. The person-time incidence rates of endocarditis were 1.2 and 3.9 cases/100 person-years in the surgical and PPVI groups, respectively (P=.03). Clinical presentations, microbiology, and outcomes were comparable in both groups. The implantation-endocarditis time interval was much shorter in the patients in the PPVI group (P=.0065). A past history of endocarditis was found to correlate with endocarditis (P=.004). Infective endocarditis was more frequent in patients with bovine jugular vein valves compared with others (7.1% vs 0.84%, P=.0117; odds ratio, 9). 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 PPVI group, respectively (P=.6). Event-free probability including endocarditis was comparable (P=.1). There is a higher incidence of endocarditis in patients with PPVI compared with surgical pulmonary valves. Clinical and biological features were comparable in both groups. The role of bovine jugular veins in the development of endocarditis is concerning. However, despite a higher incidence of endocarditis in the PPVI group, the probabilities of survival and event-free survival were similar to the surgical group.