Many Patients With Pulmonary Valve Infective Endocarditis Found to Require Surgical Management

A great percentage of patients with pulmonary valve infective endocarditis were found to require surgical management, according to a study published in Heart, Lung and Circulation.

In this retrospective study, the data of 24 patients with pulmonary valve infective endocarditis (mean age at diagnosis, 41.5 years; range, 30–57.3 years) who were treated at the Cleveland Clinic between 2002 and 2018, were examined. The electronic medical records were used to determine a diagnosis of infective endocarditis, and pulmonary valve involvement was determined based on transthoracic echocardiography, transesophageal echocardiography, or intraoperative findings. Additional demographic and clinical variables were collected from electronic medical records. Patients were subdivided based on their risk factor profiles: “miscellaneous” risk factors (n=11), coronary heart disease (CHD; n=9), use of injectable drugs (PWID; n=4). All-cause mortality was the study’s primary outcome.

Patients with miscellaneous risk factors were significantly older at time of diagnosis than patients with CHD and PWID (54±14 vs 32±14 and 34±10 years, respectively; P <.01).

A total of 13 patients (54.2%) with pulmonary valve infective endocarditis had prosthetic valves. The most common micro-organisms were coagulase-negative Staphylococci species in patients with miscellaneous risk factors and CHD, and Staphylococcus aureus in PWID. The development of endocarditis after prosthetic pulmonary valve replacement occurred at a median of 48 months. A greater percentage of isolated cases of pulmonary valve infective endocarditis occurred in patients with CHD and PWID compared with patients with miscellaneous risk factors (88.9% and 100% vs 36.4%, respectively; P =.01).

In this cohort, 75% of patients required and underwent surgical management, and the other 25% underwent medical management only. During the median follow-up period of 2.8 years, 3 in-hospital deaths occurred, all of which were in patients with miscellaneous risk factors. The observed inter-group difference in survival (P =.03) was thought to be mainly be associated with better outcomes in patients with CHD vs other risk factors.

Limitations of the study include the small sample size, retrospective design, and the inclusion of patients from a single center.

“Management of patients with [pulmonary valve infective endocarditis] is…controversial, in part due to the limited evidence available, and also due to the fact that patients with right-sided IE are often excluded from the trials included to support the guidelines. Our results demonstrate that a high proportion of patients with [pulmonary valve infective endocarditis] required surgical management (75%), rather than medical management alone,” concluded the study authors.

Reference

Isaza N, Shrestha NK, Gordon S, et al. Contemporary outcomes of pulmonary valve endocarditis: A 16-year single centre experience [published online June 11, 2020]. Heart Lung Circ. doi:0.1016/j.hlc.2020.04.015