Lifetime Endocarditis Risk with Congenital Heart Disease and Pulmonary Valve Prosthesis (PVP): Results from the German Registry for Congenital Heart Defects (CHD)

Background: Freedom from endocarditis is usually calculated starting at the implantation of a certain device. With the Register data we were able to investigate the lifetime endocarditis risk for patients with congenital heart defects who received a pulmonary valve prosthesis.

Method: We evaluated data of 997 patients having obtained 1,823 pulmonary valve prostheses between 1957 and 2018 regarding endocarditis risk related to patient age. We used Kaplan–Meier curves and log-rank tests to assess endpoint and group differences between patients with malformations requiring single- (SVR) or double-valve replacement (DVR) over time.

Results: Total observation time was 23,870 years, mean 23.8 years. Ninety-six patients were affected by endocarditis. Main malformations of SVR patients were tetralogy of Fallot (336 patients/34%) and pulmonary atresia (166/17%); main diagnoses of DVR patients were truncus arteriosus communis (TAC; 158/16%), aortic valve anomalies (90/9%), double outlet right ventricle (DORV 78/8%), and transposition of the great arteries (58/6%). DVR patients had significantly (p < 0.001) lower freedom from endocarditis than SVR patients (72 vs. 90% at 50 years). Among DVR patients, those with aortic valve malformations (mainly Ross patients) and TAC approached continuously an endocarditis rate of 50% before their 50th year of life.

Conclusion: In the German CHD Register population, the endocarditis risk at 50 years for CHD patients with pulmonary valve prostheses is 10% with single valve malformations, 30% with double valve malformations and 50% with TAC or aortic valve malformation and PVR. Such numbers might promote considerations about adapted endocarditis prophylaxis for patient groups found to be at high risk.

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Artikel online veröffentlicht:
03. Februar 2022