Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, California.
Division of Pediatric Cardiology, Kaiser Permanent Southern California, Los Angeles, California.
Catheter Cardiovasc Interv. 2019 Oct 1;94(4):625-635. doi: 10.1002/ccd.28474. Epub 2019 Aug 30.
We sought to delineate the risk factors for infective endocarditis (IE) in patients undergoing transcatheter pulmonary valve replacement (TCPVR).
Despite the therapeutic benefits of TCPVR for treatment of dysfunctional right ventricular outflow tracts, IE is a major complication of the approach. Specific hemodynamic gradients and patient immune status as predisposing factors for IE are largely unexplored.
We performed a retrospective review of patients who had undergone TCPVR at UCLA between October 2010 and October 2017. Cases of IE were diagnosed based on the modified Duke criteria.
Two hundred and thirty-five cases of TCPVR were performed with a mean follow-up of 2.6 years (range 0.0-8.0 years). Sixteen distinct IE events developed in 13 patients (Melody™ n = 12, SAPIEN n = 1), with a median time from implant to IE of 3.3 years (range 2.0-7.2 years). Univariate Cox regression showed that immunocompromised status was significantly associated with the development of IE hazard ratios (HR 5.43 [1.80-16.4], p = .003). Kaplan-Meier curves show that the 5-year freedom from IE among immunocompetent patients was 87% (95% CI 78-96%) versus 64% (95% CI 39-89%) among immunocompromised patients (log-rank p = .02). Postimplant right ventricular systolic pressure was higher among immunocompromised patients (p = .03). The risk of IE post-TCPVR in immunocompromised patients with residual pulmonary stenosis was 43%.
Among the risk factors examined in this study, immunocompromised status was the most significant predictor of IE development post-TCPVR. Patients with the lowest risk of IE are those with competent immune systems, without a history of IE, and with minimal residual pulmonary valve gradients post-TCPVR.
我们旨在确定行经导管肺动脉瓣置换术（TCPVR）患者发生感染性心内膜炎（IE）的风险因素。
尽管 TCPVR 治疗功能性右心室流出道功能障碍具有治疗益处，但 IE 是该方法的主要并发症。IE 的主要易感因素，包括特定的血流动力学梯度和患者的免疫状态，在很大程度上尚未得到探索。
我们对 2010 年 10 月至 2017 年 10 月期间在加州大学洛杉矶分校接受 TCPVR 的患者进行了回顾性研究。IE 病例的诊断基于改良的 Duke 标准。
共进行了 235 例 TCPVR，平均随访时间为 2.6 年（范围 0.0-8.0 年）。13 名患者（Melody™12 例，SAPIEN 1 例）共发生 16 例不同的 IE 事件，从植入到 IE 的中位时间为 3.3 年（范围 2.0-7.2 年）。单变量 Cox 回归显示，免疫抑制状态与 IE 发生显著相关，风险比（HR）为 5.43（1.80-16.4），p =.003。Kaplan-Meier 曲线显示，免疫功能正常患者的 5 年 IE 无事件生存率为 87%（95%CI 78-96%），而免疫抑制患者为 64%（95%CI 39-89%）（对数秩检验，p =.02）。免疫抑制患者的植入后右心室收缩压较高（p =.03）。免疫抑制患者经 TCPVR 治疗后并发残余肺动脉瓣狭窄的 IE 风险为 43%。
在本研究中检查的风险因素中，免疫抑制状态是 TCPVR 后发生 IE 的最显著预测因素。IE 风险最低的患者是那些具有正常免疫功能、无 IE 病史和 TCPVR 后最小残余肺动脉瓣梯度的患者。
