title: Infective endocarditis following Melody valve implantation: comparison with a surgical cohort.
abstract: BACKGROUND
  Infective endocarditis has been reported post Melody percutaneous pulmonary valve implant; the incidence and risk factors, however, remain poorly defined. We identified four cases of endocarditis from our first 25 Melody implants. Our aim was to examine these cases in the context of postulated risk factors and directly compare endocarditis rates with local surgical valves.
  
  
  METHODS
  We conducted a retrospective review of patients post Melody percutaneous pulmonary valve implant in New Zealand (October, 2009-May, 2015) and also reviewed the incidence of endocarditis in New Zealand among patients who have undergone surgical pulmonary valve implants.
  
  
  RESULTS
  In total, 25 patients underwent Melody implantation at a median age of 18 years. At a median follow-up of 2.9 years, most were well with low valve gradient (median 27 mmHg) and only mild regurgitation. Two patients presented with life-threatening endocarditis and obstructive vegetations at 14 and 26 months post implant, respectively. Two additional patients presented with subacute endocarditis at 5.5 years post implant. From 2009 to May, 2015, 178 surgical pulmonic bioprostheses, largely Hancock valves and homografts, were used at our institution. At a median follow-up of 2.9 years, four patients (2%) had developed endocarditis in this group compared with 4/25 (16%) in the Melody group (p=0.0089). Three surgical valves have been replaced.
  
  
  CONCLUSIONS
  The Melody valve offers a good alternative to surgical conduit replacement in selected patients. Many patients have excellent outcomes in the medium term. Endocarditis, however, can occur and if associated with obstruction can be life threatening. The risk for endocarditis in the Melody group was higher in comparison with that in a contemporaneous surgical pulmonary implant cohort.
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service,Starship Children's Hospital,Auckland,New Zealand.
authors.forename: Clare
authors.initials: C
authors.lastname: O'Donnell
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service,Starship Children's Hospital,Auckland,New Zealand.
authors.forename: Rhonda
authors.initials: R
authors.lastname: Holloway
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service,Starship Children's Hospital,Auckland,New Zealand.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Tilton
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service,Starship Children's Hospital,Auckland,New Zealand.
authors.forename: John
authors.initials: J
authors.lastname: Stirling
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service,Starship Children's Hospital,Auckland,New Zealand.
authors.forename: Kirsten
authors.initials: K
authors.lastname: Finucane
authors.affiliation: Green Lane Paediatric and Congenital Cardiac Service,Starship Children's Hospital,Auckland,New Zealand.
authors.forename: Nigel
authors.initials: N
authors.lastname: Wilson
mesh_terms: D000293:Adolescent; D000328:Adult; D001705:Bioprosthesis / Q000009:adverse effects*; D006328:Cardiac Catheterization; D002648:Child; D004696:Endocarditis / Q000175:diagnosis / Q000453:epidemiology / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009520:New Zealand / Q000453:epidemiology; D011474:Prosthesis Design; D016459:Prosthesis-Related Infections / Q000453:epidemiology / Q000209:etiology*; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D011666:Pulmonary Valve Stenosis / Q000601:surgery*; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult
keywords: Transcatheter valve; congenital intervention; follow-up