Surgical Outcomes of Pulmonary Valve Infective Endocarditis: A United States Population-Based Analysis
Yesh Datar, Ramkumar Balasubramaniyan, Kanhua Yin, Eric Awtry, Anna Cervantes-Arslanian, Simeon Kimmel, Maura Fagan, Zoe Weinstein, Karl Karlson, Niloo Edwards, David McAneny, Nikola Dobrilovic
Boston University Medical Center, Boston/Roxbury, Massachusetts, United States
Objective
Right-sided infective endocarditis (IE) accounts for 5-10% of IE and almost exclusively involves the tricuspid valve. Pulmonary valve IE is exceedingly rare, with few reports in the literature. This study aimed to understand the surgical outcomes of pulmonary valve IE at a population level.
Design
Retrospective, observational study using National Inpatient Sample (NIS) database (2002-2017).
Setting
NIS is a hospital discharge database representing 20% of all inpatient admissions to non-federal hospitals in the US.
Patients
Included hospital admissions(patients) whose primary diagnosis was IE and underwent pulmonary valve replacement or repair, and excluded patients who underwent Ross procedure.
Interventions
None.
Main Outcome Measure(s)
The primary outcome was in-hospital mortality. Secondary outcomes included postoperative complications and length of hospital stay.
Results
Among 51,159 who had a primary diagnosis of IE identified between 2002 and 2017, 56 patients (0.1%) received surgical treatment of pulmonary valve IE: 43 isolated pulmonary valve replacement, and 13 isolated repair cases. The cohort"s median age was 31.5 years (IQR=17-49), 13% were women, and 46% were White. Most patients were treated in large (76%), urban teaching (88%) hospitals. Overall, the in-hospital mortality was 8%. Postoperatively, stroke was observed in 5% of patients, bleeding 20%, acute kidney injury 0%, and complete heart block 7%. The median length of hospital stay was 15.5 days (IQR=10-28).
Conclusion
Pulmonary valve IE treated with surgery is exceedingly rare. Results of surgical interventions are encouraging, with in-hospital mortality and morbidities significantly lower than IE involving other valves.
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