Prevention and management of endocarditis after transcatheter pulmonary valve replacement: current status and future prospects

ABSTRACT

Introduction: Transcatheter pulmonary valve replacement (TPVR) has become an important tool in the management of congenital heart disease with abnormalities of the right ventricular outflow tract. Endocarditis is one of the most serious adverse long-term outcomes and among the leading causes of death in patients with congenital heart disease and after (TPVR).

Areas covered: This review discusses the current state knowledge about the risk factors for and outcomes of endocarditis after transcatheter pulmonary valve replacement in patients with congenital and acquired heart disease. It also addresses practical measures for mitigating endocarditis risk, as well as diagnosing and managing endocarditis when it does occur.

Expert opinion: With increasing understanding of the risk factors for and management and outcomes of endocarditis in patients who have undergone TPVR, we continue to learn how to utilize TPVR most effectively in this complex population of patients.

KEYWORDS:

• Pulmonary valve
• transcatheter valve
• tetralogy of Fallot
• percutaneous valve
• pulmonary regurgitation

Article highlights

• This article provides a critical analysis of the current state of knowledge regarding endocarditis after transcatheter pulmonary valve replacement.

• It also reviews concisely the best evidence about risk factors for endocarditis in this population.

• Understanding of risk factors can help mitigate endocarditis, through a combination of patient selection, guided preventive therapy, and education about recognition and prompt evaluation.

• Management of endocarditis after transcatheter pulmonary valve replacement confirms that many patients do not require invasive therapy.

• There remains much to learn about the long-term impact and nature of this complication.

Declaration of interest

D McElhinney serves as a proctor and consultant for Medtronic Inc. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose. 

Additional information

Funding

This paper was not funded.