title: Bloodstream infections occurring in patients with percutaneously implanted bioprosthetic pulmonary valve: a single-center experience.
abstract: BACKGROUND
  Percutaneous pulmonary valve implantation using a stent-based bioprosthetic valve provides an alternative to surgery in select patients. Systemic infections in Melody valve-implanted patients with and without identified valve involvement have been reported, yet the incidence is unknown, and risk factors remain unidentified.
  
  
  RESULTS
  Between 2007 and 2012, a total of 147 consecutive patients with congenital heart disease underwent Melody percutaneous pulmonary valve implantation at our institution. Demographic and clinical variables were collected at baseline and at follow-up and analyzed as predictors. The occurrence of bloodstream infection (BSI), defined as a bacterial infection treated with ≥4 weeks of antibiotics, served as our primary outcome. The mean age at implantation for the study population was 21.5±11 years, and tetralogy of Fallot was the cardiac condition in 59%. During a median follow-up of 19 months, 14 patients experienced BSI (9.5%; 95% confidence interval, 5.3%-15%). Of these, 4 (2.7%) patients had Melody valve endocarditis. Two patients died during the event, neither of whom had known valve involvement. The median procedure to infection time was 15 months (range, 1-56). In univariate analysis, male sex, previous endocarditis, in situ stents in the right ventricular outflow tract, and presence of outflow tract irregularities at the implant site were associated with BSI occurrence.
  
  
  CONCLUSIONS
  In this cohort, 9.5% of patients who underwent Melody percutaneous pulmonary valve implantation experienced subsequent BSI, occurring 1 to 56 months after implant, and 2.7% of patients had prosthetic endocarditis. Our findings suggest that patient and nonvalve anatomic factors may be associated with BSI after percutaneous pulmonary valve implantation.
authors.affiliation: Department of Cardiology and the Division of Infectious Diseases, Departments of Medicine and Laboratory Medicine, Boston Children's Hospital, Boston, MA 02115, USA..
authors.forename: Jonathan
authors.initials: J
authors.lastname: Buber
authors.forename: Lisa
authors.initials: L
authors.lastname: Bergersen
authors.forename: James E
authors.initials: JE
authors.lastname: Lock
authors.forename: Kimberlee
authors.initials: K
authors.lastname: Gauvreau
authors.forename: Jesse J
authors.initials: JJ
authors.lastname: Esch
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Landzberg
authors.forename: Anne Marie
authors.initials: AM
authors.lastname: Valente
authors.forename: Thomas J
authors.initials: TJ
authors.lastname: Sandora
authors.forename: Audrey C
authors.initials: AC
authors.lastname: Marshall
mesh_terms: D000293:Adolescent; D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001705:Bioprosthesis / Q000009:adverse effects*; D001900:Boston / Q000453:epidemiology; D002675:Child, Preschool; D004697:Endocarditis, Bacterial / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000628:therapy*; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D015994:Incidence; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000097:blood / Q000175:diagnosis / Q000188:drug therapy / Q000453:epidemiology* / Q000382:microbiology; D011664:Pulmonary Valve / Q000000981:diagnostic imaging; D011859:Radiography; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents
keywords: congenital cardiac defect; infection; percutaneous valve implantation