The Risk of Bacterial Endocarditis after Percutaneous Pulmonary Valve Implantation—A Meta-analysis of the Currently Available Valves

Background: Interventional percutaneous pulmonary valve implantation (PPVI) was first reported in 2000; today, two different valves are certified for this procedure (Medtronic Melody valve and Edwards Sapien valves). For a decade, studies have reported an increasing risk of bacterial endocarditis after PPVI; the published incidence however remains unclear.

Methods: A systematic literature search in the databases Medline, Cochrane Library, and Embase including Google Scholar was performed until December 2017. The aim was to summarize and compare the incidence of endocarditis after percutaneous pulmonary valve replacement.

Results: A total of 741 publications were identified searching for “percutaneous pulmonary valve implantation and PPVI,” 38 publications were used for final analysis. The follow-up time was between 2 and 108 months, 2,972 patients with melody valves and 321 with Sapien valves were included. Endocarditis after percutaneous pulmonary valve replacement occurred in 151 patients with Melody valves and in 5 patients with Sapien. The pooled incidence for Melody and Sapien was 4.2% (95% CI: 3.1–5.5) and 2.0 (95% CI: 0.5–3.4), respectively.

Conclusion: In general, systematic reviews proved an increasing number of endocarditis after PPVI especially for the Melody valve. To reduce the risk of post-PPVI endocarditis, the Sapien valves seem to be beneficial. The reason for this finding may be explained by the different manufacturing process reducing the risk of bacterial adherence in Sapien valves.