Choice of valve affects infection risk after percutaneous pulmonary valve implantation
Valve choice appears to affect the risk of infective endocarditis (IE) after interventional percutaneous pulmonary valve implantation (PPVI), reports a recent meta-analysis.
Accessing the databases of Medline, the Cochrane Library and Embase, researchers retrieved 47 studies eligible for inclusion in the analysis. The study outcome was the summarized cumulative incidence of IE following PPVI, compared between the types of valves.
Overall, 3,616 patients (mean age, 21±6 years) received the Medtronic Melody valve while 501 (mean age, 23±5 years) were treated with the Edward Sapien valve. The corresponding numbers of IE cases were 214 and five, leading to respective pooled incidence rates of 4.9 percent and 1.3 percent.
Sensitivity analysis further revealed a large difference in incidence rate ratios between the Melody (252.1) and Sapien (2.7) valves.
On the other hand, infections tended to develop quicker in patients treated with the Sapien valves, with a mean time to IE of 2±0 months. In comparison, patients in the Melody valve group developed IE after an average of 20±16 months.
Sapien valves, however, remained superior in terms of severity outcomes. For instance, in 60 percent of all IE cases, antibiotic treatment alone was sufficient. In contrast, only 43 percent of IE patients in the Melody group could be treated with antibiotics alone, and 8 percent died.
“To the best of our knowledge, this review is the most comprehensive meta-analysis on this important topic published so far,” said researchers. “Based on the data analysis reviewed here, there was a clear evidence to suggest that IE after PPVI was less common with Sapien valves than after implantation of a Melody valve.”