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Infective endocarditis less common with Sapien device after percutaneous valve implantation
Infective endocarditis appeared to be less common after percutaneous pulmonary valve implantation with the Sapien pulmonic transcatheter heart valve vs. the Melody valve, according to published data.
The estimated annual incidence of infective endocarditis after percutaneous pulmonary valve implantation with the Melody valve (Medtronic) is about 3%, the researchers noted, but less is known about the more recently approved Sapien valve (Edwards Lifesciences) for the procedure. To learn more, the researchers conducted an observational, retrospective study comparing outcomes of the two valves.
Of 79 patients who underwent percutaneous pulmonary valve implantation from 2008 to 2016 at a single center in France (median age, 24.9 years; 48 men), 40.5% received the Melody valve and 59.5% received the Sapien valve. Eight patients (10.1%) — all of whom were implanted with the Melody valve — developed infective endocarditis at a median of 1.8 years after the procedure.
After Melody valve implantation, the incidence of infective endocarditis was 5.7% (95% CI, 2.9-11.4) per person-year, with Kaplan-Meier cumulative incidences of 24% (95% CI, 12.2-43.9) after 4 years and 30.1% (95% CI, 15.8-52.5) after 6 years vs. 0% with the Sapien valve after 4 years (log-rank P < .04). The researchers also noted a trend toward increased incidence in the first 20 patients, who received prophylactic antibiotics during the procedure only, as well in patients who had percutaneous interventions, dental care or noncardiac surgery after implantation.
Methicillin-sensitive Staphylococcus aureus, S. epidermis, Streptococcus mitis, Aerococcus viridans, Corynebacterium striatum and Haemophilus influenzae were identified as causative organisms in those with infective endocarditis.
“Given its efficacy and decreased risk of [infective endocarditis], the Sapien valve may deserve to be recommended as the valve of first choice for [percutaneous pulmonary valve implantation] in patients with a suitable [right ventricular outflow tract],” the researchers wrote. “Prospective multicenter comparative studies with longer follow-ups are needed to further assess this issue.” – by Melissa Foster
Disclosure: The researchers report no relevant financial disclosures.