Lluri Gentian, Levi Daniel S, Miller Emily, Hageman Abbie, Sinha Sanjay, Sadeghi Soraya, Reemtsen Brian, Laks Hillel, Biniwale Reshma, Salem Morris, Fishbein Gregory A, Aboulhosn Jamil
Department of Medicine, Division of Cardiology, David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
Department of Pediatrics, Division of Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, California.
Catheter Cardiovasc Interv. 2018 Feb 1;91(2):277-284. doi: 10.1002/ccd.27312. Epub 2017 Sep 12.
To provide a comparison of the outcome of infective endocarditis (IE) in patients undergoing transcatheter pulmonary valve replacement (TPVR) versus surgical pulmonary valve replacement (SPVR).
Although TPVR is thought to be associated with a higher risk of IE than SPVR, there is paucity of data to support this.
Patients who underwent TPVR or SPVR at UCLA between October 2010 and September 2016 were included and retrospectively analyzed.
Three hundred forty-two patients underwent PVR at UCLA including 134 SPVR and 208 TPVR. Patients undergoing TPVR were more likely to have had a history of endocarditis than those undergoing SPVR (5.3% vs. 0.7%, P = 0.03) and a right ventricle to pulmonary artery (RV to PA) conduit (37% vs. 17%, P = 0.0001). Two SPVR and seven TPVR patients developed IE with a 4-year freedom from endocarditis of 94.0% in the SPVR versus 84% in the TPVR group (P = 0.13). In patients who underwent TPVR and developed endocarditis, the mean gradient across the RVOT prior to intervention was higher (28.1 ± 4.5 vs. 17.4 ± 0.6 mmHg, P = 0.02) and were more likely to have a conduit (71% vs. 36%, P = 0.049).
In this study, patients undergoing TPVR were not at a higher risk of IE than patients undergoing SPVR. TPVR patients were more likely to have had a prior history of IE and RV-PA conduit. The patients at highest risk were those with stenotic RV to PA conduits who were treated with TPVR.
比较经导管肺动脉瓣置换术（TPVR）与外科肺动脉瓣置换术（SPVR）治疗感染性心内膜炎（IE）的疗效。
尽管认为TPVR比SPVR发生IE的风险更高，但缺乏数据支持这一点。
纳入2010年10月至2016年9月在加州大学洛杉矶分校接受TPVR或SPVR的患者，并进行回顾性分析。
342例患者在加州大学洛杉矶分校接受了肺动脉瓣置换术，其中134例行SPVR，208例行TPVR。与接受SPVR的患者相比，接受TPVR的患者更可能有感染性心内膜炎病史（5.3%对0.7%，P = 0.03）和右心室至肺动脉（RV至PA）管道（37%对17%，P = 0.0001）。2例SPVR患者和7例TPVR患者发生了IE，SPVR组4年无感染性心内膜炎生存率为94.0%，TPVR组为84%（P = 0.13）。在接受TPVR并发生感染性心内膜炎的患者中，干预前经右心室流出道（RVOT）的平均压差更高（28.1±4.5对17.4±0.6 mmHg，P = 0.02），且更可能有管道（71%对36%，P = 0.049）。
在本研究中，接受TPVR的患者发生IE的风险并不高于接受SPVR的患者。TPVR患者更可能有IE和RV-PA管道的既往史。风险最高的患者是接受TPVR治疗的RV至PA管道狭窄患者。
