Malekzadeh-Milani Sophie, Ladouceur Magalie, Patel Mehul, Boughenou Fazia-Marie, Iserin Laurence, Bonnet Damien, Boudjemline Younes
Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Necker Hospital for Sick Children-HEGP, AP-HP, Paris, France.
Centre de Référence Malformations Cardiaques Congénitales Complexes (M3C), Necker Hospital for Sick Children-HEGP, AP-HP, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France.
Arch Cardiovasc Dis. 2015 Feb;108(2):97-106. doi: 10.1016/j.acvd.2014.09.003. Epub 2014 Oct 30.
Percutaneous pulmonary valve replacement (PPVR) has achieved standard of care for the management of dysfunctional right ventricular outflow tract.
Because of increasing reports of Melody(®) valve (Medtronic, Inc., Minneapolis, MN, USA) infective endocarditis (IE), we aimed to evaluate its incidence and predictors of occurrence.
We collected data on all patients who received a Melody valve in the pulmonary position from 2009 to 2012.
A total of 86 consecutive patients underwent PPVR from 2009 to 2012; of these, five developed IE (5.8%). Freedom from IE was 91% at 50 months. Baseline demographics, type of conduit, PPVR procedural success, residual gradients and in situ duration of Melody valve were similar in IE and non-IE patients. A significant number of IE patients had additional unprotected invasive procedures during follow-up and abruptly discontinued antiplatelet therapy (P=0.0139 and P=0.002, respectively). The cumulative probability of survival without cardiovascular events for IE patients was 20% at 20 months, compared with 98.1% for non-IE patients (P<0.0001). Death was statistically associated with IE.
Early- and late-onset IE of the Melody valve is emerging as a catastrophic complication of PPVR. Abrupt aspirin discontinuation and additional unprotected invasive procedures during follow-up are significant predictors of Melody valve IE. Owing to its rapidly progressive nature, aggressive invasive management should not be delayed.
经皮肺动脉瓣置换术（PPVR）已成为治疗功能失调的右心室流出道的标准治疗方法。
由于美敦力公司（美国明尼阿波利斯）的Melody瓣膜感染性心内膜炎（IE）的报告日益增多，我们旨在评估其发生率及发生的预测因素。
我们收集了2009年至2012年期间所有在肺动脉位置接受Melody瓣膜的患者的数据。
2009年至2012年共有86例连续患者接受了PPVR；其中5例发生了IE（5.8%）。50个月时无IE的发生率为91%。IE患者和非IE患者在基线人口统计学、管道类型、PPVR手术成功率、残余压差及Melody瓣膜在位时间方面相似。相当数量的IE患者在随访期间进行了额外的无保护侵入性操作，并突然停用抗血小板治疗（分别为P = 0.0139和P = 0.002）。IE患者无心血管事件生存的累积概率在20个月时为20%，而非IE患者为98.1%（P < 0.0001）。死亡与IE在统计学上相关。
Melody瓣膜的早发和迟发IE正成为PPVR的灾难性并发症。随访期间突然停用阿司匹林和进行额外的无保护侵入性操作是Melody瓣膜IE的重要预测因素。由于其进展迅速，积极的侵入性治疗不应延迟。
