Management of prosthetic pulmonary valve endocarditis should include the selective application of transcatheter pulmonary valve replacement

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Structured Abstract: Objective Prosthetic pulmonary valve endocarditis (PPVE) limits survival and quality of life in patients with repaired congenital heart disease (CHD). We describe single center PPVE patient outcomes and the application of transcatheter pulmonary valve replacement (TPVR). Methods We performed a single center retrospective review of patients with PPVE from 2010-2022. Subjects were stratified by initial treatment. Group 1: surgical pulmonary valve replacement (SPVR), Group 2: TPVR, Group 3: initial medical therapy without plans for upfront surgical or procedural intervention. Micro-organism data, post-treatment morbidity, length of stay (LOS), recurrence, and mortality are reported. Results 70 patients met inclusion criteria. 7% (Group 2) underwent TPVR and 80% of these patients underwent TPVR as a bridge to SPVR. No group 2 patients had recurrence. Mortality was similar in the upfront SPVR and TPVR groups (Group 1: 17.4%, Group 2: 20%, Group 3: 2.4%). 71% of Group 3 patients eventually required elective SPVR or TPVR with 25% of patients undergoing TPVR after clearance of blood cultures having recurrence compared to 7.1% of patients who underwent SPVR after clearance of blood cultures. Conclusions TPVR is a viable bridge to SPVR in select patients with PPVE and may serve as destination therapy. Recurrence may be more common in patients requiring PVR after clearance of infection. Prospective studies of first-line TPVR as a strategy for bridge-to-surgery in select high risk patients and destination therapy in patients with resolution of bacteremia are needed to define treatment pathways.

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