Infective Endocarditis in Stent-Mounted Bovine Jugular Vein Conduits: Clinical Experience and Evaluation of the Modified Duke Criteria

Objectives: Percutaneous pulmonary valve implantation (PPVI) has proven good hemodynamic results. As infective endocarditis (IE) remains a potential complication and clinical data on the subject are limited we reviewed our patient records to improve future strategies of IE prevention, diagnosis, and treatment.

Methods: Medical records of all patients diagnosed with Melody valve IE according to the modified Duke criteria were retrospectively analyzed in three Belgian tertiary centers.

Result: Twenty-three IE episodes in 22 out of 240 patients were identified (incidence 9.6%) with a clear male predominance (86%). Median age at IE was 17.9 years (range, 8.2–45.9 years) and median time from PPVI to IE was 2.4 years (range, 0.7–8 years). In 13/23 IE episodes, a possible entry point was identified. Streptococcal species caused 10 infections, followed by Staphylococcus aureus (n = 5). IE was classified as definite in 15 and as possible in 8 cases. Echocardiography visualized vegetations in 10 patients, PET-CT showed positive FDG signals in five patients and intracardiac echocardiography verified a vegetation in one patient. Ten patients had a hemodynamically relevant pulmonary stenosis at IE presentation. Nine early and six late percutaneous or surgical reinterventions were performed which were more frequent in both Staphylococcus species (five of seven) and HACEK-group organisms (three of three). No IE related deaths occurred.

Conclusion: IE after Melody valve PPVI is associated with a relevant need of reinterventions. Communication to patients and physicians about risk factors is essential in prevention. The modified Duke’s criteria underperformed in diagnosing definite IE, but inclusion of new imaging modalities might improve diagnostic performance.