-
JACC. Cardiovascular Interventions Feb 2015The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve... (Review)
Review
OBJECTIVES
The aim of this review is to describe the incidence, features, predisposing factors, and outcomes of prosthetic valve endocarditis (PVE) after transcatheter valve replacement (TVR).
BACKGROUND
Very few data exist on PVE after TVR.
METHODS
Studies published between 2000 and 2013 regarding PVE in patients with transcatheter aortic valve replacement (TAVR) or transcatheter pulmonary valve replacement (TPVR) were identified through a systematic electronic search.
RESULTS
A total of 28 publications describing 60 patients (32 TAVRs, 28 TPVRs) were identified. Most TAVR patients (66% male, 80 ± 7 years of age) had a very high-risk profile (mean logistic EuroSCORE: 30.4 ± 14.0%). In TPVR patients (90% male, 19 ± 6 years of age), PVE was more frequent in the stenotic conduit/valve (61%). The median time between TVR and infective endocarditis was 5 months (interquartile range: 2 to 9 months). Typical microorganisms were mostly found with a higher incidence of enterococci after TAVR (34.4%), and Staphylococcus aureus after TPVR (29.4%). As many as 60% of the TAVR-PVE patients were managed medically despite related complications such as local extension, embolism, and heart failure in more than 50% of patients. The valve explantation rate was 57% and 23% in balloon- and self-expandable valves, respectively. In-hospital mortality for TAVR-PVE was 34.4%. Most TPVR-PVE patients (75%) were managed surgically, and in-hospital mortality was 7.1%.
CONCLUSIONS
Most cases of PVE post-TVR involved male patients, with a very high-risk profile (TAVR) or underlying stenotic conduit/valve (TPVR). Typical, but different, microorganisms of PVE were involved in one-half of the TAVR and TPVR cases. Most TPVR-PVE patients were managed surgically as opposed to TAVR patients, and the mortality rate was high, especially in the TAVR cohort.
Topics: Endocarditis; Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Incidence; Pulmonary Valve; Risk Factors; Transcatheter Aortic Valve Replacement
PubMed: 25700757
DOI: 10.1016/j.jcin.2014.09.013 -
Journal of the American College of... May 2023
Topics: Humans; Pulmonary Valve; Tetralogy of Fallot; Cardiac Surgical Procedures
PubMed: 37225361
DOI: 10.1016/j.jacc.2023.04.005 -
Interactive Cardiovascular and Thoracic... Apr 2021Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for... (Review)
Review
OBJECTIVES
Many surgeons develop unique techniques for unmet needs for right ventricular outflow reconstruction to resolve pulmonary regurgitation after corrective surgery for congenital heart diseases. Expanded polytetrafluoroethylene (ePTFE) stands out as a reliable synthetic material, and clinical results with handmade ePTFE valves have been promising. This review focuses on the historical evolution of the use of ePTFE in pulmonary valve replacement and in the techniques for pioneering the translation of the handmade ePTFE trileaflet design for the transcatheter approach.
METHODS
We searched for and reviewed publications from 1990 to 2020 in the Pubmed database. Nineteen clinical studies from 2005 to 2019 that focused on ePTFE-based valves were summarized. The evolution of the ePTFE-based valve over 3 decades and recent relevant in vitro studies were investigated.
RESULTS
The average freedom from reintervention or surgery in the recorded ePTFE-based valve population was 90.2% at 5 years, and the survival rate was 96.7% at 3 years.
CONCLUSIONS
Non-inferior clinical results of this ePTFE handmade valve were revealed compared to allograft or xenograft options for pulmonary valve replacement. Future investigations on transferring ePTFE trileaflet design to transcatheter devices should be considered.
Topics: Heart Valve Prosthesis; Heart Valve Prosthesis Implantation; Humans; Polytetrafluoroethylene; Prosthesis Design; Pulmonary Valve; Treatment Outcome
PubMed: 33377488
DOI: 10.1093/icvts/ivaa302 -
The Journal of Thoracic and... Apr 2018
Topics: Bioprosthesis; Heart Valve Prosthesis; Humans; Pulmonary Valve; Pulmonary Valve Insufficiency
PubMed: 29395196
DOI: 10.1016/j.jtcvs.2017.12.092 -
Journal of Biomechanical Engineering Jan 2023The Ross procedure using the inclusion technique with anticommissural plication (ACP) is associated with excellent valve hemodynamics and favorable leaflet kinematics....
The Ross procedure using the inclusion technique with anticommissural plication (ACP) is associated with excellent valve hemodynamics and favorable leaflet kinematics. The objective was to evaluate individual pulmonary cusp's biomechanics and fluttering by including coronary flow in the Ross procedure using an ex vivo three-dimensional-printed heart simulator. Ten porcine and five human pulmonary autografts were harvested from a meat abattoir and heart transplant patients. Five porcine autografts without reinforcement served as controls. The other autografts were prepared using the inclusion technique with and without ACP (ACP and NACP). Hemodynamic and high-speed videography data were measured using the ex vivo heart simulator. Although porcine autografts showed similar leaflet rapid opening and closing mean velocities, human ACP compared to NACP autografts demonstrated lower leaflet rapid opening mean velocity in the right (p = 0.02) and left coronary cusps (p = 0.003). The porcine and human autograft leaflet rapid opening and closing mean velocities were similar in all three cusps. Porcine autografts showed similar leaflet flutter frequencies in the left (p = 0.3) and noncoronary cusps (p = 0.4), but porcine NACP autografts versus controls demonstrated higher leaflet flutter frequency in the right coronary cusp (p = 0.05). The human NACP versus ACP autografts showed higher flutter frequency in the noncoronary cusp (p = 0.02). The leaflet flutter amplitudes were similar in all three cusps in both porcine and human autografts. The ACP compared to NACP autografts in the Ross procedure was associated with more favorable leaflet kinematics. These results may translate to the improved long-term durability of the pulmonary autografts.
Topics: Animals; Aortic Valve; Autografts; Biomechanical Phenomena; Heart Valve Prosthesis; Hemodynamics; Humans; Pulmonary Valve; Swine; Transplantation, Autologous
PubMed: 35864775
DOI: 10.1115/1.4055033 -
Multimedia Manual of Cardiothoracic... Nov 2023The Ross-Personalized External Aortic Root Support procedure is a surgical aortic valve replacement technique in which the autologous pulmonary valve is transposed in...
The Ross-Personalized External Aortic Root Support procedure is a surgical aortic valve replacement technique in which the autologous pulmonary valve is transposed in the aortic position to replace the malfunctioning aortic valve and a homograft is implanted in the pulmonary position. To prevent autograft dilatation, a Personalized External Aortic Root Support prosthesis is included in the proximal autograft anastomosis and wrapped around the ascending aorta. The aorta is transected transversely, the aortic valve is resected, and the coronary arteries are mobilized and cut out of the sinuses, leaving a rim. The pulmonary autograft is harvested by transecting the pulmonary artery and part of the right ventricular outflow tract. The autograft is approximated to the aortic root and inverted inside the ventricle. The proximal anastomosis is performed including the prosthesis between the aortic root and the autograft. The coronary buttons are threaded through appropriately positioned and sized holes in the prosthesis and reimplanted into the autograft. The ascending aorta is appropriately adapted and anastomosed with the distal autograft. When the patient is off cardiopulmonary bypass, the prosthesis can be closed longitudinally and is anchored to the distal aortic adventitia.
Topics: Humans; Autografts; Aorta, Thoracic; Transplantation, Autologous; Aortic Valve; Aorta; Aortic Valve Stenosis; Aortic Valve Insufficiency; Pulmonary Valve; Heart Valve Prosthesis Implantation; Reoperation
PubMed: 37942704
DOI: 10.1510/mmcts.2023.077 -
JACC. Cardiovascular Interventions Jan 2022
Topics: Cardiac Surgical Procedures; Heart Valve Prosthesis Implantation; Humans; Longitudinal Studies; Pulmonary Valve; Treatment Outcome
PubMed: 35057988
DOI: 10.1016/j.jcin.2021.12.001 -
Journal of the American College of... Jan 2022
Topics: Cardiac Surgical Procedures; Humans; Pulmonary Valve; Tetralogy of Fallot
PubMed: 34991786
DOI: 10.1016/j.jacc.2021.10.032 -
Journal of the American College of... Dec 2018Endocarditis has emerged as one of the most concerning adverse outcomes in patients with congenital anomalies involving the right ventricular outflow tract (RVOT) and... (Clinical Trial)
Clinical Trial
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).
Topics: Adolescent; Adult; Child; Endocarditis, Bacterial; Equipment Contamination; Female; Follow-Up Studies; Heart Valve Diseases; Heart Valve Prosthesis Implantation; Humans; Male; Middle Aged; Postoperative Complications; Prospective Studies; Pulmonary Valve; Pulmonary Valve Insufficiency; Young Adult
PubMed: 30497557
DOI: 10.1016/j.jacc.2018.09.039 -
The American Journal of Case Reports Feb 2019BACKGROUND Infective endocarditis (IE) has a high mortality rate, even when treated with appropriate antibiotic therapy and surgical intervention. Right-sided...
BACKGROUND Infective endocarditis (IE) has a high mortality rate, even when treated with appropriate antibiotic therapy and surgical intervention. Right-sided endocarditis is in itself rare, with some studies reporting an incidence of 5-10%. The majority of these cases involve the tricuspid valve, and isolated pulmonary valve endocarditis (PVE) is an extremely rare entity affecting less than 2% of patients with infective endocarditis. Identification and early management are crucial to prevent long-term complications and reduce mortality. CASE REPORT We present a patient with a history of essential hypertension and no underlying valvular disease, who underwent dental cleaning and subsequently developed low-grade fever, myalgia, and malaise. This occurred during the flu season, and was initially diagnosed and treated as flu, without any improvement. The patient was later found to be bacteremic with S. mitis, with no identifiable source, and a normal transthoracic echocardiogram (TTE). He was later hospitalized, had a transesophageal echocardiogram, and was found to have a large pulmonic valve vegetation. CONCLUSIONS This case presents an interesting and rare finding of endocarditis, isolated to the pulmonic valve, in an otherwise healthy individual with no predisposing risk factors. The lack of peripheral stigmata, as well as an unremarkable initial outpatient TTE, made the diagnosis more difficult. It should also be noted that current guidelines do not specifically address right-sided endocarditis, and do not specify the role of surgical intervention.
Topics: Dental Prophylaxis; Echocardiography; Endocarditis, Bacterial; Humans; Male; Middle Aged; Pulmonary Valve; Streptococcal Infections; Streptococcus mitis
PubMed: 30713335
DOI: 10.12659/AJCR.913041