Reflection and Rationalization
Making Sense of the Literature on Endocarditis After Transcatheter Pulmonary Valve Replacement
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- follow-up studies
- percutaneous valve
- pulmonary valve
- Ross procedure
- tetralogy of Fallot
In previous editorial comments, my focus has tended to settle on issues concerning how to develop and interpret the body of literature related to uncommon or new procedures, particularly when the literature comprises mainly small and observational studies with nonuniform or limited follow-up after implantation of devices that are likely to have much longer-term implications. This general theme is fundamental to the fields of congenital and structural interventional cardiology and pervades my editorial perspective and practice with Circulation: Cardiovascular Interventions. The topic I take on below is in the same vein, although it includes a more thorough review of a specific issue that I have been struggling with for several years: endocarditis after transcatheter pulmonary valve replacement (TPVR).
Endocarditis after TPVR with the Melody valve (Medtronic, Inc, Minneapolis, MN) was first described by Khambadkone et al1 in a 2005 article summarizing their first 59 procedures. That initial patient was again reported, along with 4 others, in a 2008 update of their experience.2 Since those early reports, endocarditis has emerged as one of the most important and vexing adverse outcomes after TPVR. Endocarditis has been observed in general case series of TPVR2–8 and has been the organizing feature of several multicenter or single-center cohort studies9–14 and several small case series and case reports.15–24 It has also been the topic of several reviews that did not include new cases.25–27 In addition, endocarditis has been reported after TPVR with Sapien valves as well.28,29
Although the published data have brought the issue of post-TPVR endocarditis to light, the picture, both in isolation and in the broader context of this patient population, remains disconcertingly unclear. The literature, although growing, may be best characterized as nascent and ambiguous. …