3 risk factors associated with endocarditis after TPVR
Endocarditis after transcatheter pulmonary valve replacement (TPVR) is more common in patients who are younger, have a history of endocarditis or have a high residual gradient after TPVR, according to a new multicenter study published in the Journal of the American College of Cardiology.
“As numerous studies have demonstrated, patients with complex conotruncal heart defects and those repaired with prosthetic material, especially valve-containing prostheses, are at particularly high risk for developing endocarditis,” wrote first author Doff B. McElhinney, MD, director of the pulmonary artery reconstruction program at Stanford University School of Medicine, and colleagues. “Accordingly, endocarditis has emerged as one of the more common and clinically important time-related adverse events in patients with a transcatheter pulmonary valve (TPV).”
McElhinney et al. tracked data from nearly 2,500 patients from 15 different facilities who underwent TPVR with either a Melody valve or Sapien valve from July 2005 to March 2020. Overall, 7.3% of patients were diagnosed with endocarditis a median of 2.7 years after the procedure. This equals a cumulative incidence rate of 9.5% after 5 years and 16.9% after 8 years.
Younger patients as well as patients with a history of endocarditis or a high residual gradient after the procedure were all more likely to develop endocarditis. The TPV type, the authors added, did not impact a patient’s risk of endocarditis.
“Some of the potential predisposing factors that were identified, such as immunodeficiency, were patient-related features that theoretically could have been but were not necessarily ascertained for the entire cohort, thus precluding evaluation of their contribution to general endocarditis risk,” the authors wrote. “In contrast, other mitigating factors, such as unprotected dental procedures, cutaneous infections, or other circumstantial portals of entry, were situational and would be very difficult to collect for the entire cohort and assess as general risk factors. Nevertheless, it is important to enumerate and discuss those factors in the context of the study, in part to reinforce the importance of education and anticipatory guidance. The pathophysiology of endocarditis after TPVR is almost certainly complex and variable, and identification of situational risk factors is important, even if doing so does not contribute to assessment of general risk.”
The team also emphasized that additional research was still needed to help clinicians “develop strategies for prevention and management of endocarditis” in this patient population.
Read the full study here.
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.