Centre de Référence Malformations Cardiaques Congénitales, Complexes-M3C, Necker Hospital for Sick Children, George-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris (AP-HP), 75015 Paris, France.
Department of Paediatric and Adult Cardiology, Centre Hospitalier Régional et Universitaire de Lille, 59000 Lille, France.
Arch Cardiovasc Dis. 2018 Aug-Sep;111(8-9):497-506. doi: 10.1016/j.acvd.2017.10.007. Epub 2018 Mar 9.
Percutaneous pulmonary valve implantation (PPVI) is a routine treatment for dysfunctional right ventricular outflow tract. Infective endocarditis (IE) is a major concern.
To report French experience with the Melody™ valve (Medtronic Inc., Minneapolis, MN, USA).
All patients who underwent PPVI were recorded in a multicentre French national survey. Demographic and procedural data were collected from patients with IE. Bacterial identification, diagnostic tools and outcome were recorded.
Forty-five cases of IE were diagnosed in 43 patients. The cumulative IE incidence was 11.8% (95% confidence interval [CI] 8.5-15.9). The annualized IE incidence was 3.6% (95% CI 0-4.8). Freedom from IE was 96.3% and 85.8% at 12 months and 60 months, respectively. IE incidence did not change during the study period. The mean interval between PPVI and IE was 2.6±2.1 years (range, 5 days to 7.3 years). Fifteen patients with IE required intravenous antibiotics only. Seven patients had early interventional cardiac catheterization to relieve severe right ventricular outflow tract obstruction. Twenty-four patients had surgical valve replacement (six urgently; nine semi-urgently; nine electively). Staphylococcus aureus IE required surgery in all but one patient. Three patients died before any treatment. Three additional patients died, giving a mortality rate of 14%. Global survival in the total cohort of patients who received a Melody valve was excellent (96.5% at 5 years). When comparing survival curves between the IE and non-IE groups, death and cardiovascular events were statistically significantly higher in the IE group (log-rank P<0.0001).
Melody valve IE is a severe complication following PPVI. The annualized IE incidence in this cohort was similar to rates reported in other studies. With rapid diagnosis and adequate treatment, outcome has improved, and unfavourable outcome is mainly associated with S. aureus.
经皮肺动脉瓣植入术（PPVI）是治疗右心室流出道功能障碍的常规治疗方法。感染性心内膜炎（IE）是一个主要关注点。
报告法国使用 Melody™瓣膜（美敦力公司，明尼苏达州明尼阿波利斯市）的经验。
在一项多中心法国全国性调查中，记录了所有接受 PPVI 的患者。从 IE 患者中收集人口统计学和程序数据。记录细菌鉴定、诊断工具和结果。
在 43 名患者中诊断出 45 例 IE。IE 的累积发生率为 11.8%（95%置信区间 [CI] 8.5-15.9）。IE 的年发生率为 3.6%（95%CI 0-4.8）。12 个月和 60 个月时，IE 无复发率分别为 96.3%和 85.8%。在研究期间，IE 的发生率没有变化。PPVI 和 IE 之间的平均间隔为 2.6±2.1 年（范围，5 天至 7.3 年）。15 例 IE 患者仅接受静脉内抗生素治疗。7 例患者早期进行介入性心脏导管术以缓解严重的右心室流出道梗阻。24 例患者接受了手术瓣膜置换（6 例紧急；9 例半紧急；9 例择期）。除 1 例外，金黄色葡萄球菌 IE 均需手术治疗。3 例患者在任何治疗前死亡。另外 3 例患者死亡，死亡率为 14%。接受 Melody 瓣膜的患者总队列的总体生存率非常好（5 年时为 96.5%）。在 IE 组和非 IE 组之间比较生存曲线时，IE 组的死亡和心血管事件发生率显著更高（对数秩 P<0.0001）。
Melody 瓣膜 IE 是 PPVI 后的严重并发症。该队列的年化 IE 发生率与其他研究报告的发生率相似。通过快速诊断和充分治疗，预后得到改善，不良预后主要与金黄色葡萄球菌有关。
