Outcomes Following Melody Transcatheter Pulmonary Valve Implantation for Right Ventricular Outflow Tract Dysfunction in Repaired Congenital Heart Disease: First Reported Australian Single Centre Experience

The standing of percutaneous pulmonary valve implantation compared to surgery in a non-preselected cohort with dysfunctional right ventricular outflow tract – Reasons for failure and contraindications

“…It has been stated that a position of the coronary arteries directly contacting the conduit without any intervening tissue may predict coronary artery compression during PPVI [30]. As conduit calcification could increase the risk of PPVIassociated conduit injury, these patients are excluded by some authors [32]. In our study only patients with a RVOT clearly exceeding the potential size of the largest valve available for PPVI (i.e.…”

Initial experience with the percutaneous implant of the Melody® valve in a hospital center in Mexico City

“…In the late 20 th century, it was thought that pulmonary valve insufficiency, one of the usually described CHD surgical repair complications that involve RVOT, would be well tolerated by the right ventricle (RV); however, experiences observed in recent years have shown that an important number of patients evolve to right heart failure, lethal arrhythmias, and sudden death [5][6][7][8][9] . Current criteria after RVOT repair in patients with complex CHD, such as tetralogy of Fallot, include clinical criteria (functional class, signs of heart failure) and RV functional variables (ejection fraction, end-systolic [ESV], and end-diastolic volume [ESV]) 9 .…”

“…Since most patients with CHD that involves RVOT will require reoperation during their lifetime, the need for options to improve approaching strategies and decrease primary correction reoperation complications was a reason for the development of new technologies aiming to restore the blood flow to the pulmonary circulation, with percutaneous technology appearing for the implantation of pulmonary bioprostheses [1][2][3][4][5][6][7][8][9] .…”

“…The Melody ® valve consists of a 34-mm platinum-iridium bare stent (CP stent, NuMED Inc.; Hopkinton, New York, USA), with one valve made with a bovine jugular vein segment. The device is attached to a balloon catheter and released on a 22-Fr sleeve [1][2][3][4][5][6][7][8][9][10] . Despite its size, the use of the Melody ® valve was intended for those patients with RVOT diameters of < 24 mm, which limited the benefit to a specific group of patients.…”

“…EDV > 150 mL/m 2 BSA or ESV > 80 ml/m 2 BSA; (b) RV systolic dysfunction, RVEF < 45%; (c) sustained atrial/ventricular tachycardia; (d) RVOT obstruction, RV systolic pressure (RVSP) > 75% of systemic pressure or higher than 80 mmHg; and (e) significant progressive tricuspid regurgitation. -In symptomatic patients: (a) moderate to severe respiratory failure and (b) significant stenosis: RVSP > 60 mmHg [3][4][5][8][9][10][11]17 . One of the principles for the decision of this alternative for RVOT dysfunction is to precisely understand the anatomy.…”