Nationwide Registry-Based Analysis of Infective Endocarditis Risk After Pulmonary Valve Replacement

Stammnitz C, Huscher D, Bauer UMM, Urban A, Nordmeyer J, Schubert S, Photiadis J, Berger F, Klaassen S; German Competence Network for Congenital Heart Defects Investigators.J Am Heart Assoc. 2022 Mar;11(5):e022231. doi: 10.1161/JAHA.121.022231. Epub 2022 Feb 18.PMID: 35179045


Take Home Points:

  • Bovine jugular vein valves (Contegra/Melody) have the highest risk of infective endocarditis, irrespective of the mode of deployment (surgical or percutaneous)
  • Male sex and higher number of previous pulmonary valve replacements increase risk of Infective Endocarditis

Commentary from Dr. Shailendra Upadhyay (Connecticut, USA), section editor of ACHD Journal Watch:

This study is the largest retrospective analysis of the German NR-CHD (National Register for Congenital Heart Defects) comparing the risk of infectious endocarditis (IE) after percutaneous pulmonary valve implantation or surgical pulmonary valve replacement in congenital heart disease.

All patients with CHD with at least 1 surgical pulmonary valve replacement (SPVR) or percutaneous pulmonary valve replacement (PPVI) before January 1, 2018 [January 2007-Dec 2017] were included and followed up for the combined end point (grafts infected or explanted, or the patient was deceased).

The study included 1170 patients (median age 12, 5-20 years, 56% males, 68% < 18 years) that included 1598 surgical pulmonary valve replacement (SPVR) including – aortic/pulmonary homograft, heterograft including Contegra, bio-prosthetic valved conduits using Bovine/Porcine materials, mechanical valves and percutaneous pulmonary valve implantation (PPVR) including Melody and Edward Sapien valves.

Diagnoses included: Tetralogy of Fallot (TOF)- commonest, Truncus Arteriosus, Aortic stenosis and s/p Ross operation. Total follow-up was 9397 years (per patient median 10 years). Clinical characteristics of patients is noted in table 2.

IE occurred in 4.8% during a 10-year median follow-up (6-10 years), tables 1 and 2.

IE After homograft 1.3%; IE After heterograft 4.3% [Heterograft non Contegra 2.5% and Contegra 5.4%]; IE After Melody 7.5%.



IE showed no significance influence on the overall survival of the patients ([HR], 3.57; P=0.20).

Bovine jugular vein valves (Contegra and Melody) had the highest risk of IE [Table S4], irrespective of the mode of deployment, either surgical or percutaneous. In the multivariable analysis, the risk of IE was increased in the male sex, in patients with a higher number of previous pulmonary valve replacement and for bovine jugular vein valves (with a similar risk for Melody versus Contegra valves). [Table 3].




  • Homograft or non Contegra heterograft replacement has the least risk of IE.
  • Bovine jugular valves (Contegra/Melody) have the highest risk of IE whether deployed surgically or percutaneously.
  • Male sex and higher number of previous PVR add significant IE risk.
  • Other significant risk factors for IE are male sex and higher numbers of previous PVR.
  • The Edwards-Sapien valve may be useful for PPVI in high risk subgroups for IE, however data are limited.