Risk Of Endocarditis Research Articles

Prevalence of dental caries in children with congenital heart disease

BackgroundCongenital heart defects (CHD) affect about 8 out of 1000 births worldwide. Most of the patients reach adulthood and are exposed to an increased risk of endocarditis. Since bacteria already enter the bloodstream during everyday activities, oral hygiene is given special importance in the prevention of endocarditis.MethodsIn this study 81 boys (55.1%) and 66 (44.9%) girls with CHD received a dental exam and additionally an assessment using the DIAGNOdent® pen. This study group consisting of patients with CHD was matched with a healthy epidemiological control group in Germany.ResultsEighty-one boys (55.1%) and 66 (44.9%) girls were examined. The mean age was 11 ± 4 years.38.8% showed at least one untreated carious lesions. 37.4% had a dmft/DMFT ≥2 and thus represented a group with an increased caries risk.The dmft value was 2.12 ± 1.25 in the age group 3-6 year olds. In the group of the 7-12 year old patients the DMFT/dmft was 2.06 ± 2.27, whereas DMFT in 13-17 year olds was at 2.12 ± 1.58. However, children and adolescents with CHD had a higher DMF index than healthy children in the same age group.ConclusionsThe present study reveals that more than one third of those examined have a dental condition in need of rehabilitation. In future, close interdisciplinary cooperation between pediatric cardiologists and dentists should ensure regular dental check-ups.

Oral hygiene and gingival disease among children with structural heart disease at a tertiary hospital in North-Central Nigeria

Background: Poor oral hygiene and gingival disease are factors that increase risk of infective endocarditis in children with structural heart disease. The objectives were to evaluate the oral hygiene status of children with structural heart disease and the prevalence of dental caries/ gingival disease among them.
 Methods: Descriptive, cross-sectional study. Subjects were children aged6 months to 14 years with structural heart disease. Relevant sociodemographic and clinical data were collected. The Decayed, Missing Filled –Teeth (DMF-T) index and Simplified Oral Hygiene index-S (OHI-S) were used to evaluate for dental caries and oral hygiene respectively.
 Results: Forty-eight subjects were recruited. Median (IQR) age was 1.88 (0.50 – 6.75) years. Commonest structural heart diseases were ventricular septal defects (19 subjects; 39.6%), rheumatic heart disease (6; 12.5%), and Tetralogy of Fallot (5; 10.4%). Prevalence of dental caries amongst subjects was 11.4% (four of the 35). Six (12.5%) had gingival disease and one (2.9%) had poor oral hygiene. Thirty-two (91.4%) subjects had their mouth cleaned daily, while only four (12.5%) of these had it cleaned at least twice a day.
 Conclusion: Dental caries and poor oral hygiene are common amongst children with structural heart disease.

In adults, risk for infective endocarditis varied for invasive dental procedures and by antibiotic prophylaxis.

Thornhill MH, Gibson TB, Yoon F, et al. Antibiotic prophylaxis against infective endocarditis before invasive dental procedures. J Am Coll Cardiol. 2022;80:1029-41. 35987887.

Fungal Infective Endocarditis Post Device Occlusion in Perimembranous Ventricular Septal Defect

Recent increase in deployment of trans-catheter devices such as septal or ductal occluding coils and devices has been a possible risk factor for infective endocarditis, predominantly in the initial post deployment period before endothelialization has ensued. Though a long-term study of trans-catheter Atrial Septal Defect (ASD) closure revealed no cases of Infective Endocarditis, some case reports of endocarditis in trans-catheter device closure of ASD, VSD and Patent ductus arteriosus(PDA) advocate that residual defect after device occlusion may be a factor in the risk for Infective Endocarditis. We herein describe the case of a 9-month-old female patient who underwent device closure for peri-membranous ventricular septal defect (VSD) and developed fungal infective endocarditis in early post occlusion period which was confirmed on blood culture. Despite treatment with appropriate antifungal as per sensitivity, clinical condition of the patient deteriorated and it was decided to manage her with surgical explanation of device and closure of defect.

Antibiotic prescription after tooth extraction in adults: a retrospective cohort study in Austria

BackgroundBroad spectrum antibiotics are often used for the prophylaxis of infectious endocarditis and treatment of odontogenic infections, but there are limited data related to antibiotic use and adherence to prescription guidelines. MethodsData from patients with tooth extraction between 2014 and 2018 were selected from a database of a regional health insurance fund. We created three data sets, one based on all tooth extractions, one on multiple teeth extractions, and one including only single tooth extraction. After data collection, descriptive analysis was carried out. The differences in prescription pattern of antibiotic medicine were tested by χ2 test, Student´s t-test or ANOVA.ResultsFrom 43,863 patients with tooth extraction, 53% were female, and 3,983 patients (9.1%) filled a prescription for antibiotic medicine. From 43,863 patients, 157 patients (0.4%) had endocarditis risk, but only 8 patients of these (5.1%) filled an antibiotic prescription. In total, 9,234 patients had multiple and 34,437 patients had only one tooth extraction. Patients with more than one tooth extraction received more often antibiotic treatment (10.7%) compared to those with single tooth extractions (χ2 = 36; p < 0,001). Patients with more than one tooth extraction were older, however, younger patients received antibiotics more frequently (t = 28,774, p = 0.001). There was no relationship with endocarditis risk status. Clindamycin and amoxicillin/clavulanic acid were the most frequently prescribed antibiotic medicines.ConclusionsIn this retrospective cohort study, dentists did not discriminate prophylactic antibiotic prescription with regard to endocarditis risk status. A factor influencing prescribing behaviour of antibiotic medicines was the number of extracted teeth.

Abstract 14609: Exposure to Any Hospitalization and Specific Invasive Procedures Post Open Heart Valve Surgery Increases the Risk of Endocarditis

Introduction: Infective endocarditis (IE) after cardiac valve surgery is associated with high morbidity and mortality. Nosocomial exposure is a growing cause of IE in general. We investigated the risk of post valve surgery endocarditis (PVE) in patient who had any hospitalization and specific nosocomial exposures after open heart valve surgery. Methods: We identified all ≥18yo patients who had their first open heart cardiac valve surgery between 2001-2017 in New South Wales, Australia from the Admitted Patient Data Collection (APDC) registry. Patients with prior/current IE diagnosis at time of index valve surgery were excluded. Follow up was until 31 Dec 2018 with mortality and morbidity tracked from the respective death and APDC registries. Analyses based on Cox regression modelling included age, sex, background diagnoses and features of index valve surgery as time independent covariates, with any hospitalization (separately for specific invasive procedures) post index valve surgery as time dependent exposure covariates for risk of PVE within 6 months of exposure. Results: In total 23747 patients (median age [IQR] 73yo [65-79yo, 63% male) had cardiac valve surgery: 60% isolated aortic valve (n=15065), 28% isolated mitral valve (n=6702), 10% multiple valves (n=2385) and 1.5% right sided valves (n=357). 5.4% (n=1293) of patients experienced PVE at a median 2.9 years (IQR 0.7-6.2) after index valve surgery, with 65% (n=838) occurring within 6 months of any hospitalization. Any hospitalization exposure was associated with an adjusted hazard ratio of 4.0 for developing PVE (95% confidence interval 3.5-4.5). In addition, specific invasive procedures including repeat valve surgery were associated with an elevated risk for PVE (Figure). Conclusions: PVE is significantly more common after any hospitalization with specific invasive procedures carrying differential risk. Care should be taken to avoid unnecessary hospitalizations and procedures in these patients.

Abstract 11863: Lutembacher Syndrome - Learning From the Left Atrium

Lutembacher syndrome (LS) is a rare cardiac anomaly that was first reported in 1916 by Rene Lutembacher. LS is characterized by an atrial septal defect (ASD) combined with mitral stenosis (MS), both of which can be either congenital or acquired. Without treatment, pulmonary vascular resistance (PVR) steadily increases and can cause right-to-left ASD shunting. This greatly increases the risk of infective endocarditis (IE) and cerebrovascular accidents (CVA). - We present a 69-year-old female with past medical history of laryngeal cancer that presented with dyspnea and hemoptysis. The patient had NYHA class II symptoms and had not undergone prior cardiac work-up. - Transthoracic echocardiogram demonstrated a reduced ejection fraction 35%, calcifies mitral valve leaflets, and abnormal flow across the interatrial septum. Subsequent transesophageal echocardiogram confirmed the diagnosis of Lutembacher Syndrome with a mean mitral valve gradient of 15 mmHg and evidence of a secundum ASD. There was predominant left-to-right shunting during bubble study with transient right-to-left shunt while coughing. Moderate to severe mitral regurgitation and severe pulmonary hypertension was also observed. Wilkins score was calculated at 7. The patient was ultimately transferred to a Comprehensive Valve Center for surgical mitral valve replacement (MVR). - This case highlights the importance of understanding the pathophysiology of LS for efficient diagnosis and appropriate management. Early evaluation at a Comprehensive Valve Center is recommended. Moderate to severe mitral regurgitation is a contraindication to less invasive options such as a percutaneous mitral balloon commissurotomy (PMBC). It is crucial to recognize that after surgical MVR, the secundum ASD is expected to become smaller with predominant left-to-right shunting due to reduced PVR, which decreases the risk of IE and CVA.

Probiotics Safety Aspect of Functional Foods

ABSTRACT In recent years, interest in probiotics has increased as functional foods improve quality of life and consumers become more health-conscious. The European Food Safety Authority (EFSA) has determined that all common probiotics are safe for the general population. However, this definition does not guide the outcomes of using probiotics in people with diseases that favor them, as there are no strict regulations governing applicable trademark law and the manufacture of probiotics. For this reason, Probiotics are recognized to be beneficial for the majority of patients during treatment; however, patients with weakened immune systems may be at risk for bacteremia, endocarditis, and peritonitis. There are no necessary standards regarding safety and use protocols for probiotics. More information is needed on their use before recommending probiotics to treat or prevent disease in privileged groups. These products may be considered a public health concern by reviewing information on the use of probiotics to predict the likelihood of side effects in vulnerable groups (young children, the elderly, and pregnant women).

Long-term outcome in patients with heart failure after cardiac surgery other than coronary artery bypass grafting treated with cardiac resynchronization therapy

Abstract Background Cardiac resynchronization therapy (CRT) has been proven therapy in patients with heart failure (HF) and reduced left ventricular ejection fraction (LVEF). However, little is known about the prognosis, and the risk of cardiac device-related infective endocarditis (CDRIE) in patients with HF after cardiac surgery other than coronary artery bypass grafting (CABG) treated with CRT. Aim To assess the long-term outcome, mortality predictors, and the risk of CDRIE in patients with HF after cardiac surgery other than CABG treated with CRT. Methods The study population consisted of 1059 consecutive patients with CRT implanted between 2002 and 2019 in a tertiary care university hospital in a densely inhabited, urban region of Poland (949 subjects [89.6%] with CRT-D; 110 patients with CRT-P [10.4%]). Results The studied population was divided into two groups according to be or not after cardiac surgery other than CABG (n=74 patients [6.9%] vs. n=985 patients [93.1%]). During the median follow-up of 1661 days (10th and 90th percentile: 323–3995), all-cause mortality in patients after cardiac surgery other than CABG did not differ significantly in comparison to other CRT recipients (50% vs. 54.4%, P=0.46). Also, the risk of CDRIE was not statistically significant differ (2.7% vs. 5.7%, P=0.28). On multivariable regression analysis, only older age (HR 1.04, 95% CI 1.01–1.07, P=0.02) was identified as independent predictor of higher mortality in patients after cardiac surgery treated with CRT. Kaplan-Meier curves of survival of patients after cardiac surgery other than CABG treated with cardiac resynchronization therapy in comparison to other CRT recipients are presented on Picture 1. Conclusions The mortality rate in patients after cardiac surgery other than CABG is similar to other subjects treated with CRT and reaches 50% within 4.5 years. The risk of device-related infective endocarditis is not higher than in other patients treated with CRT. Advanced age is an independent mortality predictor in subjects after cardiac surgery other than CABG undergoing CRT. Funding Acknowledgement Type of funding sources: None.

The risk spectrum of infective endocarditis among patients with congenital heart diseases

Abstract Background Patients with congenital heart disease (CHD) are considered at lifelong high risk of infective endocarditis (IE). The risk of IE presumably differs among different types of CHD, but little knowledge exists on the area. Purpose This study set out to investigate the long-term incidence of IE among CHD-patients and associated risk factors. Methods In this observational cohort study, all patients with CHD born in 1977–2018 were identified using Danish nationwide registries and followed from date of birth until occurrence of first-time IE, emigration, death, or end of study (December 31, 2018). The comparative risk of IE among patients with CHD versus age- and sex-matched controls from the background population was assessed. Moreover, the risk of IE was stratified according to type of CHD and risk factors associated with IE among patients with CHD were examined using Cox regression analysis including sex and relevant time-varying coefficients (i.e., cyanotic yet surgically untreated CHD, CHD repaired with prostheses, diabetes mellitus, chronic kidney disease, and presence of cardiac implantable devices). Results A total of 23,464 patients with CHD (50.0% men) were identified and matched with 93,856 controls from the background population. During a median follow-up of 17.7 years, 217 (0.9%) patients with CHD and 4 (0.0%) controls developed IE, corresponding to incidence rates of 5.2 (95% CI: 4.6–6.0) and 0.02 (95% CI: 0.01–0.1) per 10,000 person-years, respectively. The associated incidence of IE was greatest among patients with tetralogy of Fallot, malformations of the heart chambers (including transposition of the great arteries and truncus arteriosus), atrioventricular septal defects, and heart valve defects (Figure 1). Factors associated with IE among patients with CHD included male sex (HR 1.7 [95% CI, 1.3–2.2]), cyanotic yet surgically untreated CHD (HR 5.2 [95% CI, 3.5–7.7]), cardiac prostheses (HR 5.2 [95% CI, 3.6–7.5]), chronic kidney disease (HR 3.1 [95% CI, 1.3–7.6]), and presence of cardiac implantable electronic devices (HR 3.1 [95% CI, 1.5–6.2]). Conclusions Patients with CHD, especially those with tetralogy of Fallot and malformations of the heart chambers, have a substantially higher incidence of IE than the background population. With an increasing longevity of these patients, relevant guidelines concerning preventive measures are decisive to improve morbidity, mortality, and the quality of life among this growing group of patients. Funding Acknowledgement Type of funding sources: None.

Risk predictors and outcomes of infective endocarditis among adult patients with congenital heart disease

Abstract Background Infective endocarditis (IE) is a serious disease associated with increased morbidity and mortality. Patients with adult congenital heart disease (ACHD) have been reported to be at a particularly increased risk of infective endocarditis (IE). Purpose To investigate the risk predictors of IE, and the long-term risk of IE among ACHD patients aged 18–65 years, compared with matched controls without ACHD, in a nationwide setting. Methods All patients with ACHD in Sweden born in years 1952–1999 and who survived until 18 years of age were followed in the National Patient Register and Cause of Death Register until year 2017. For each case of ACHD, approximately ten controls without ACHD were randomly selected from the Total Population Register and matched by birth year and sex. The study population was followed from 18 years of age and until a first time diagnosis of IE, death or end of study. Both comorbidities and occurrence of ACHD related surgery were collected from 1970 and onwards. Cox proportional hazard models were used to predict the risk of IE. Results Altogether, 36,189 ACHD patients and 403,962 controls without ACHD were included. A total of 706 (1.95%) ACHD patients and 147 (0.04%) controls developed IE during a median follow-up of 15.5 (interquartile range (IQR) 6.9–28.5) years (ACHD) and 15.5 (IQR 7.5–28.5) years (controls). ACHD patients were somewhat younger at age of IE diagnosis compared with controls, median age 33.9 (IQR 25.4–44.1) years in ACHD vs 39.8 (IQR 30.6–52.0) years in controls. The overall risk of IE was markedly higher among ACHD patients compared with controls, with a hazard ratio (HR) of 54.8 (95% confidence interval (CI), 45.9–65.5). More than one third of the ACHD patients with IE (n=272, 38.5%) had undergone any kind of previous congenital heart surgery whereof 122 (44.9%) had undergone valve replacement (mechanical/biological) prior to IE. In ACHD patients, the most important risk predictors for IE were ACHD related cardiac surgery and valve replacement surgery, HR 117 (95% CI 93.0–148) and HR 74.8 (95% CI 56.4–99.2), respectively. Diabetes mellitus, previous ischemic stroke and presence of an intracardiac electronic device also predicted the risk of IE, however, they were less important predictors (diabetes: HR 1.69, 95% CI 1.01–2.82, ischemic stroke: HR 1.75, 95% CI 1.21–2.52, electronic device: HR 1.59, 95% CI 1.05–2.39). Conclusion The risk of developing IE was found to be almost 55 times higher in patients with ACHD aged 18–65 years compared with matched controls. Previous ACHD related surgery and valve replacement were the most significant risk predictors. These results underscore the need of continuous clinical follow-up as well as the need of further research to prevent this serious complication of ACHD. Funding Acknowledgement Type of funding sources: Foundation. Main funding source(s): The work was supported by grants from the Swedish state under an agreement between the Swedish government and country councils, the ALF-agreement (grant numbers 236611 and 917361); and the Swedish Heart-Lung Foundation (grant number: 20180644 and 20200521).

Ten-year clinical and echocardiographic follow-up of third-generation biological prostheses in the aortic position

ObjectivesPERIMOUNT Magna Ease (Carpentier-Edwards; PME) prostheses have been widely implanted during the past decade for aortic valve replacement (AVR). Although promising results at midterm follow-up were reported, long-term outcome has yet to be confirmed. On this study we aimed to evaluate long-term results in terms of structural valve degeneration (SVD), major clinical outcomes, long-term hemodynamic valve performance, and left ventricular remodeling. MethodsFrom 2010 to 2012, 689 consecutive patients underwent AVR with PME. Complete clinical 10-year follow-up was obtained. The degree of SVD was categorized on the basis of the latest guidelines. Echocardiographic data were analyzed at 1, 5, and 10 years. Competing risk analysis was performed for major events. Cumulative incidence of SVD, reoperation, and endocarditis were also assessed according to prosthetic sizes (19-21-23 mm vs 25-27-29 mm) and age (<65 vs 65-75 vs >75 years old). ResultsThe overall cumulative incidence reported for SVD ≥2 and reoperation were 3.6% and 1.9% at 10 years, respectively. An early left ventricular reverse remodeling was noted after implantation and confirmed at follow-up. Patients younger than 65 years showed higher cumulative incidence of SVD ≥2 at 10 years compared with patients aged 65 to 75 and older than 75 years (9.7% vs 2.6% vs 2.7%; P = .013), as well as of redo AVR (7.8% vs 3.3% vs 0.4%; P = .002). There was no difference in terms of SVD and redo AVR for different prosthetic size categories (P > .05). The risk of endocarditis was similar among age and size groups. ConclusionsPME provides very good durability at long-term and could be considered one of the high performing third-generation bioprostheses for AVR.

CANDIDA ALBICANS AS A CAUSE OF PACEMAKER LEAD ENDOCARDITIS : A CASE REPORT AND REVIEW OF THE LITERATURE

CANDIDA ALBICANS AS A CAUSE OF PACEMAKER LEAD ENDOCARDITIS : A CASE REPORT AND REVIEW OF THE LITERATURE

Excess Reintervention With Mitroflow Prosthesis for Aortic Valve Replacement: Ten-Year Outcomes of a Randomized Trial

BackgroundCurrent bioprostheses are considered to have improved durability and better hemodynamic performance compared with previous designs, but there are limited comparative data on late outcomes. MethodsFrom 2009 through 2011, 300 adults with severe aortic valve stenosis undergoing aortic valve replacement (AVR) were randomly assigned to receive Edwards Magna, St Jude Epic, or Sorin Mitroflow bioprostheses (n = 100, n = 101, n = 99, respectively). Overall survival was analyzed using Kaplan-Meier and Cox proportional hazards methods, whereas competing risk analysis was used for all time-to-event outcomes. Serial echocardiographic data were fitted with longitudinal models stratified by implant valve size. ResultsDuring median follow-up of 9.8 years (interquartile range, 8.7-10.2), 10-year survival was 50% for the Magna group, 42% for the Epic group, and 41% for the Mitroflow group (P = .415). Cumulative risk of stroke was 9% at 10 years, and rates were comparable for the three groups. Indexed aortic valve area and mean gradients were similar among the three groups receiving 19 mm and 21 mm valves, but in larger (23 mm or more) prostheses, gradients were lower (P < .001) and indexed aortic valve areas were higher in the Magna group (P < .001). The 10-year risk of endocarditis differed by group (P = .033), with higher incidence in the Mitroflow vs the Magna group (7% vs 0%, P = .019). Late risk of reinterventions in the Mitroflow group was 22%, compared with 0% in the Magna group (P < .001) and 5% in the Epic group (P = .008). ConclusionsThe Magna valve had the lowest gradients and largest indexed aortic valve area with larger implant sizes. The Mitroflow bioprosthesis is associated with an increased rate of reintervention and possible increased risk of infection compared with Magna and Epic valves.

Temporal association between invasive procedures and infective endocarditis

ObjectiveAntibiotic prophylaxis has been recommended for patients at increased risk of infective endocarditis (IE) undergoing specific invasive procedures (IPs) despite a lack of data supporting its use. Therefore, antibiotic prophylaxis...

Transcatheter vs Surgical Aortic Valve Replacement in Pure Native Aortic Regurgitation

BackgroundPatients with pure native aortic regurgitation (AR) have been excluded from transcatheter aortic valve replacement (TAVR) trials. We sought to examine midterm outcomes with TAVR in AR compared with surgical AVR (SAVR) in a contemporary cohort. MethodsMedicare beneficiaries who underwent elective TAVR or SAVR for pure AR from 2016 to 2019 were identified. Patients with concomitant aortic stenosis and who underwent a valve-in-valve intervention or concomitant mitral valve or ascending aorta operation were excluded. The primary outcome was all-cause mortality in the longest follow-up. Secondary outcomes included stroke, endocarditis, and redo AVR. Overlap propensity score weighting was used to adjust for confounders. ResultsDuring the study period, 11,027 patients with pure AR underwent elective AVR (TAVR, n = 1147; SAVR, n = 9880). SAVR patients were younger, with fewer comorbidities and less frailty compared with TAVR patients. TAVR was associated with adjusted 30-day mortality comparable to SAVR. After a median follow-up of 31 months (interquartile range, 18-44 months), TAVR was associated with higher adjusted risk of death (hazard ratio [HR], 1.41; 95% CI, 1.03-1.93; P = .02) and need for redo-AVR (HR, 2.13; 95% CI, 1.05-4.34; P = .03) compared with SAVR. The risk of stroke (HR, 1.65; 95% CI, 0.95-2.87; P = .07) and endocarditis (HR, 2.60; 95% CI, 0.92-7.36; P = .07) was numerically higher with TAVR. ConclusionsIn Medicare patients with pure native AR, TAVR with the current commercially available transcatheter valves has comparable short-term outcomes. Although long-term outcomes were inferior to SAVR, the possibility of residual confounding, biasing long-term outcomes, given older and frailer TAVR patients, cannot be excluded.

The risk of endocarditis in hemodialysis patients who have undergone invasive dental treatment: a cohort case-control analysis of the Taiwan National Health Insurance Database.

The objective of this study was to determine if hemodialysis patients who have undergone an invasive dental treatment are at risk of developing infective endocarditis. This study was a cohort case-control design and used secondary data collected from the National Health Insurance Research Database of Taiwan. The case group and the control group were each comprised of 19,602 hemodialysis patients. The control group was matched for four variables: age, gender, a medical history of diabetes mellitus, and a cerebrovascular event. After matching, the case group and the control group were each comprised of 19,602 hemodialysis patients. Cox regression analysis determined hazard ratios and 95% confidence intervals. Patients were followed up at 1month and 3months after receiving invasive dental treatment. The results showed the cohort case-control hazard ratio was 0.88 (95% CI, 0.49, 1.57) 1month after receiving invasive dental treatment. Three months after receiving IDT, the cohort case-control hazard ratio was 1.04 (95% CI, 0.71, 1.52). Hazard ratios did not differ significantly between groups. Hemodialysis patients who received invasive dental treatment had no greater risk of developing infective endocarditis than matched control patients. The results of this study should alleviate concerns for hemodialysis patients and dentists about invasive dental treatment procedures. We recommend hemodialysis patients undergo invasive dental treatment when needed. The results of this study showed that invasive dental treatment did not increase their risk of developing infective endocarditis. Hemodialysis patients in need of an invasive dental procedure should be encouraged to undergo treatment if the dentist deems it necessary.

Infective Endocarditis in High-Income Countries.

Infective endocarditis remains an illness that carries a significant burden to healthcare resources. In recent times, there has been a shift from Streptococcus sp. to Staphylococcus sp. as the primary organism of interest. This has significant consequences, given the virulence of Staphylococcus and its propensity to form a biofilm, rendering non-surgical therapy ineffective. In addition, antibiotic resistance has affected treatment of this organism. The cohorts at most risk for Staphylococcal endocarditis are elderly patients with multiple comorbidities. The innovation of transcatheter technologies alongside other cardiac interventions such as implantable devices has contributed to the increased risk attributable to this cohort. We examined the pathophysiology of infective endocarditis carefully. Inter alia, the determinants of Staphylococcus aureus virulence, interaction with host immunity, as well as the discovery and emergence of a potential vaccine, were investigated. Furthermore, the potential role of prophylactic antibiotics during dental procedures was also evaluated. As rates of transcatheter device implantation increase, endocarditis is expected to increase, especially in this high-risk group. A high level of suspicion is needed alongside early initiation of therapy and referral to the heart team to improve outcomes.

Long-Term Follow-Up of Right Ventricle to Pulmonary Artery Biologic Valved Conduits Used in Pediatric Congenital Heart Surgery

Valved conduit reconstruction between the right ventricle (RV) and the pulmonary circulation is often necessary in the surgical treatment of complex congenital heart defects. The aim of this study is to evaluate the long-term performance of the three types of conduits we have used and assess risk factors for conduit failure. Retrospective, single-center review of 455 consecutive pediatric patients with 625 conduits from 1990 to 2019 undergoing RV-to-pulmonary artery (PA) reconstruction with a valved conduit. The three conduit types investigated were pulmonary homograft, aorta homograft, and bovine jugular vein (BJV) graft. Overall patient survival was 91.4%, freedom from conduit replacement (FCR) was 47.4%, and freedom from reintervention (FFR) was 37.8% with a median follow-up of 8.7 years (interquartile range 4.3–13.3 years). For pulmonary homografts, 10-, 20-, and 28-year FCR was 79.6%, 68.6%, and 66.0%, respectively. For aortic homografts, 10-, 20-, and 30-year FCR was 49.8%, 31.5%, and 23.0%, respectively. For BJV grafts, 10- and 19-year FCR was 68.1% and 46.0%, respectively. When controlling for baseline variables, FCR was similar for pulmonary homografts and BJV grafts. Overall patient survival was excellent. Risk factors for conduit failure in patients operated with reconstruction of the RV-PA outflow tract included low age, low weight, small conduit size, and certain cardiac diagnoses. There was no evidence for a shorter life span of the second graft. Pulmonary homografts and BJV grafts performed similarly but the risk of endocarditis was greater in the BJV group.

Infective endocarditis after transcatheter approach versus surgical pulmonary valve replacement: A meta-analysis.

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.