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.

Publication History

Article published online:
03 February 2022