Department of Pediatric Cardiology Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health Berlin Germany.
Competence Network for Congenital Heart Defects National Register for Congenital Heart Defects Berlin Germany.
J Am Heart Assoc. 2022 Mar;11(5):e022231. doi: 10.1161/JAHA.121.022231. Epub 2022 Feb 18.
Background Infective endocarditis (IE) after pulmonary valve replacements in congenital heart disease is a significant concern. This study aimed to identify specific long-term risk factors for IE after percutaneous pulmonary valve implantation or surgical pulmonary valve replacement. Methods and Results All patients with congenital heart disease from the National Register for Congenital Heart Defects with at least 1 pulmonary valve replacement before January 2018 were included. A total of 1170 patients (56.3% men, median age at study inclusion 12 [interquartile range {Q1-Q3} 5-20 years]) received 1598 pulmonary valve replacements. IE occurred in 4.8% of patients during a follow-up of total 9397 patient-years (median 10 [Q1-Q3, 6-10] years per patient). After homograft implantation 7 of 558 (1.3%) patients developed IE, after heterograft implantation 31 of 723 (4.3%) patients, and after Melody valve implantation 18 of 241 (7.5%) patients. Edwards Sapien and mechanical valves were used less frequently and remained without IE. The incidence of IE in heterografts excluding Contegra valves was 7 of 278 (2.5%), whereas the incidence of IE in Contegra valves was 24 of 445 (5.4%). The risk of IE was not increased compared with homografts if Contegra valves were excluded from the heterografts (hazard ratio [HR], 2.60; =0.075). The risk of IE was increased for bovine jugular vein valves, Contegra valves (HR, 6.72; <0.001), and Melody valves (HR, 5.49; <0.001), but did not differ between Melody valves and Contegra valves (HR, 1.01; =0.978). Conclusions Bovine jugular vein valves have the highest risk of IE, irrespective of the mode of deployment, either surgical or percutaneous.
先天性心脏病患者行肺动脉瓣置换术后发生感染性心内膜炎（IE）是一个严重的问题。本研究旨在确定经皮肺动脉瓣植入或外科肺动脉瓣置换术后 IE 的特定长期危险因素。
本研究纳入了国家先天性心脏缺陷登记处中至少接受过 1 次肺动脉瓣置换术的先天性心脏病患者，随访时间截至 2018 年 1 月前。共纳入 1170 例患者（56.3%为男性，研究纳入时的中位年龄为 12 岁[四分位距{Q1-Q3}为 5-20 岁]），共接受了 1598 次肺动脉瓣置换术。在 9397 患者年（每位患者的中位随访时间为 10[Q1-Q3，6-10]年）的随访期间，有 4.8%的患者发生 IE。同种带瓣管道植入后，558 例患者中有 7 例（1.3%）发生 IE；异种带瓣管道植入后，723 例患者中有 31 例（4.3%）发生 IE；Melody 瓣膜植入后，241 例患者中有 18 例（7.5%）发生 IE。Edwards Sapien 和机械瓣膜的使用频率较低，且未发生 IE。不包括 Contegra 瓣膜的异种带瓣管道的 IE 发生率为 7/278（2.5%），而 Contegra 瓣膜的 IE 发生率为 24/445（5.4%）。如果将 Contegra 瓣膜从异种带瓣管道中排除，IE 的风险与同种带瓣管道相比并未增加（风险比[HR]，2.60；=0.075）。牛颈静脉瓣膜、Contegra 瓣膜（HR，6.72；<0.001）和 Melody 瓣膜（HR，5.49；<0.001）的 IE 风险增加，但 Melody 瓣膜和 Contegra 瓣膜之间的 IE 风险无差异（HR，1.01；=0.978）。
牛颈静脉瓣膜的 IE 风险最高，无论其部署方式是经皮还是外科。
