title: Infective endocarditis of a transcatheter pulmonary valve in comparison with surgical implants.
abstract: BACKGROUND
  Melody valved stents (Medtronic Inc, Minneapolis, Minnesota, USA) have become a very competitive therapeutic option for pulmonary valve replacement in patients with congenital heart disease. After adequate prestenting of the right ventricular outflow tract (RVOT) Melody valved stents have a good medium term functional result but are exposed to infective endocarditis (IE).
  
  
  METHODS
  Retrospective study of tertiary centre Congenital Heart Disease database; to compare incidence of IE in three different types of valved conduits in RVOT: Melody valved stent, cryopreserved homograft (European Homograft Bank) and Contegra graft (Medtronic Inc).
  
  
  RESULTS
  Between 1989 and 2013, 738 conduits were implanted in 677 patients. 107 Melody valved stents were implanted in 107 patients; IE occurred in 8 (7.5%) patients during a follow-up of 2.0 years (IQR 2.4 years, range 0.3-7.8 years). 577 Homografts were implanted in 517 patients; IE occurred in 14 patients (2.4%) during a median follow-up of 6.5 years (IQR 9.2 years; range 0.1-23.7 years). Finally, 54 Contegra grafts were implanted in 53 patients; 11 patients (20.4%) had IE during a follow-up of 8.8 years (IQR 7.7 years; range 0.2-3.5 years). Survival free of IE by Kaplan-Meier for homografts was 98.7% at 5 years and 97.3% at 10 years; for Contegra 87.8% at 5 years and 77.3% at 10 years and for Melody 84.9% at 5 years (log-rank test; p<0.001).
  
  
  CONCLUSIONS
  The Contegra conduit and Melody valved stents have a significantly higher incidence of IE than homografts. IE is a significant threat for long-term conduit function.
authors.affiliation: Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Ine
authors.initials: I
authors.lastname: Van Dijck
authors.affiliation: Department of Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Werner
authors.initials: W
authors.lastname: Budts
authors.affiliation: Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Bjorn
authors.initials: B
authors.lastname: Cools
authors.affiliation: Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Eyskens
authors.affiliation: Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Derize E
authors.initials: DE
authors.lastname: Boshoff
authors.affiliation: Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Ruth
authors.initials: R
authors.lastname: Heying
authors.affiliation: Department of Pediatric Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Stefan
authors.initials: S
authors.lastname: Frerich
authors.affiliation: Department of Pediatric Cardiology, Cardiovascular Research Institute Maastricht, Maastricht University Medical Center, Maastricht, The Netherlands.
authors.forename: Ward Y
authors.initials: WY
authors.lastname: Vanagt
authors.affiliation: Department of Congenital Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Els
authors.initials: E
authors.lastname: Troost
authors.affiliation: Department of Pediatric Cardiology, University Hospitals Leuven, Leuven, Belgium.
authors.forename: Marc
authors.initials: M
authors.lastname: Gewillig
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001530:Belgium / Q000453:epidemiology; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D002648:Child; D002675:Child, Preschool; D016208:Databases, Factual; D018572:Disease-Free Survival; D004697:Endocarditis, Bacterial / Q000175:diagnosis / Q000453:epidemiology* / Q000382:microbiology; D005260:Female; D006330:Heart Defects, Congenital / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D006350:Heart Valve Prosthesis; 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; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D015607:Stents; D062606:Tertiary Care Centers; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult