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Choice of valve affects infection risk after percutaneous pulmonary valve implantation

26 Jul 2019
An organ transplant surgery taken place with the “most well-respected manner,” reassures Dr Hirman. Photo credit: Dr Hasdy Haron, clinical manager at National Transplant Resource Centre, Malaysia.

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.”

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Most Read Articles
01 Dec 2019
Macrolide antibiotics are derived from the Streptomycesspecies. These contain either 14-membered (erythromycin [ERM],clarithromycin [CAM], roxithromycin [RXM]), 15-membered(azithromycin [AZM]) or 16-membered (spiramycin, josamycin,midecamycin) macrocyclic lactone rings. They inhibit proteinsynthesis by reversibly binding to the 23S ribosomal RNA (rRNA)in the 50s subunit of the bacterial ribosome. Traditionally,macrolides are used as first-line agents in respiratory, skin,soft tissue, and urogenital infections, and they are also activeagainst gram-positive cocci and atypical pathogens.
19 Jun 2019
Acquired immunodeficiency syndrome (AIDS) remains as one of the world’s leading causes of mortality in global public health. Dr Charles Hicks shared his insights into the increasing role of dolutegravir (DTG; Tivicay, GSK) – an integrase strand transfer inhibitor (INSTI) – in HIV therapy during the 4th National AIDS Conference 2018 at Swiss Garden International Hotel and Residences, Kuala Lumpur.
21 Sep 2019
Cryptococcosis is more common in nonhuman immunodeficiency virus (HIV) nontransplant (NHNT) patients, and this population tends to have more localized pulmonary cryptococcosis and significantly higher 90-day mortality, reports a study.
Stephen Padilla, 07 May 2019
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