Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis
Background: Although transcatheter pulmonary valve replacement (TPVR) with Melody and Sapien valves has been shown to be safe and effective, infective endocarditis (IE) of the valve remains a significant risk. The goal of this study is to assess how different immunocompromised states influence the l...
| Main Authors: | , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2021-05-01
|
| Series: | International Journal of Cardiology Congenital Heart Disease |
| Subjects: | |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S2666668521000422 |
| _version_ | 1819012016075964416 |
|---|---|
| author | Elizabeth Rinaldi Soraya Sadeghi Gentian Lluri Morris Salem Daniel Levi Jamil Aboulhosn |
| author_facet | Elizabeth Rinaldi Soraya Sadeghi Gentian Lluri Morris Salem Daniel Levi Jamil Aboulhosn |
| author_sort | Elizabeth Rinaldi |
| collection | DOAJ |
| description | Background: Although transcatheter pulmonary valve replacement (TPVR) with Melody and Sapien valves has been shown to be safe and effective, infective endocarditis (IE) of the valve remains a significant risk. The goal of this study is to assess how different immunocompromised states influence the likelihood of developing IE in our congenital heart disease population with these valves. Methods: A chart review was conducted of all patient who underwent TPVR at UCLA. Various risk factors including age, transcatheter valve type, and type of immunocompromised state were analyzed as possible risk factors for IE. CART analysis was used to create a visual representation of the interplay of various risk factors. Results: The incidence of IE at our institution was approximately 8% (26 events in 339 valve implants), over a median follow up of 2.92 (0.07–9.71) years. All but one event occurred in patients with Melody valves. Patients with any immunocompromised condition were more likely to develop IE (P = 0.01). Presentation severity and outcome of IE was similar for immunocompromised and non-immunocompromised patients. Patients with DiGeorge syndrome and those taking oral immunosuppressants for autoimmune conditions or asthma were at highest risk for developing IE. Conclusions: The relatively high rate of endocarditis in TPVR patients, particularly in those with Melody valves, is a concerning development. A subset of immunocompromised patients appears to be at higher risk, and it may be beneficial for providers to be especially vigilant with these patients. Further research is needed to assess long-term risk of IE in all TPVR patients. |
| first_indexed | 2024-12-21T01:37:20Z |
| format | Article |
| id | doaj.art-7168d36dbaa04e7692ae77f4d76d3388 |
| institution | Directory Open Access Journal |
| issn | 2666-6685 |
| language | English |
| last_indexed | 2024-12-21T01:37:20Z |
| publishDate | 2021-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Cardiology Congenital Heart Disease |
| spelling | doaj.art-7168d36dbaa04e7692ae77f4d76d33882022-12-21T19:20:15ZengElsevierInternational Journal of Cardiology Congenital Heart Disease2666-66852021-05-013100118Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditisElizabeth Rinaldi0Soraya Sadeghi1Gentian Lluri2Morris Salem3Daniel Levi4Jamil Aboulhosn5David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Corresponding author. The David Geffen School of Medicine at UCLA, University of California–Los Angeles, 885 Tiverton Drive Suite B27, Los Angeles, CA, 90095, USA.Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USADavid Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USADivision of Pediatric Cardiology, Kaiser Permanente Southern California, Los Angeles, CA, USADavid Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USADavid Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Cardiology, Ahmanson/UCLA Adult Congenital Heart Disease Center, David Geffen School of Medicine at UCLA, Los Angeles, CA, USA; Division of Pediatric Cardiology, David Geffen School of Medicine at UCLA, Los Angeles, CA, USABackground: Although transcatheter pulmonary valve replacement (TPVR) with Melody and Sapien valves has been shown to be safe and effective, infective endocarditis (IE) of the valve remains a significant risk. The goal of this study is to assess how different immunocompromised states influence the likelihood of developing IE in our congenital heart disease population with these valves. Methods: A chart review was conducted of all patient who underwent TPVR at UCLA. Various risk factors including age, transcatheter valve type, and type of immunocompromised state were analyzed as possible risk factors for IE. CART analysis was used to create a visual representation of the interplay of various risk factors. Results: The incidence of IE at our institution was approximately 8% (26 events in 339 valve implants), over a median follow up of 2.92 (0.07–9.71) years. All but one event occurred in patients with Melody valves. Patients with any immunocompromised condition were more likely to develop IE (P = 0.01). Presentation severity and outcome of IE was similar for immunocompromised and non-immunocompromised patients. Patients with DiGeorge syndrome and those taking oral immunosuppressants for autoimmune conditions or asthma were at highest risk for developing IE. Conclusions: The relatively high rate of endocarditis in TPVR patients, particularly in those with Melody valves, is a concerning development. A subset of immunocompromised patients appears to be at higher risk, and it may be beneficial for providers to be especially vigilant with these patients. Further research is needed to assess long-term risk of IE in all TPVR patients.http://www.sciencedirect.com/science/article/pii/S2666668521000422Congenital heart diseaseImmunocompromiseEndocarditisTranscatheter pulmonary valves |
| spellingShingle | Elizabeth Rinaldi Soraya Sadeghi Gentian Lluri Morris Salem Daniel Levi Jamil Aboulhosn Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis International Journal of Cardiology Congenital Heart Disease Congenital heart disease Immunocompromise Endocarditis Transcatheter pulmonary valves |
| title | Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis |
| title_full | Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis |
| title_fullStr | Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis |
| title_full_unstemmed | Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis |
| title_short | Immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis |
| title_sort | immunosuppression as a risk factor for developing transcatheter pulmonary valve endocarditis |
| topic | Congenital heart disease Immunocompromise Endocarditis Transcatheter pulmonary valves |
| url | http://www.sciencedirect.com/science/article/pii/S2666668521000422 |
| work_keys_str_mv | AT elizabethrinaldi immunosuppressionasariskfactorfordevelopingtranscatheterpulmonaryvalveendocarditis AT sorayasadeghi immunosuppressionasariskfactorfordevelopingtranscatheterpulmonaryvalveendocarditis AT gentianlluri immunosuppressionasariskfactorfordevelopingtranscatheterpulmonaryvalveendocarditis AT morrissalem immunosuppressionasariskfactorfordevelopingtranscatheterpulmonaryvalveendocarditis AT daniellevi immunosuppressionasariskfactorfordevelopingtranscatheterpulmonaryvalveendocarditis AT jamilaboulhosn immunosuppressionasariskfactorfordevelopingtranscatheterpulmonaryvalveendocarditis |