Surgical Atrioventricular Valve Replacement With Melody Valve in Infants and Children

Abstract

Background Pediatric patients with atrioventricular valve disease have limited options for prosthetic valve replacement in sizes <15 mm. Based on successful experience with the stented bovine jugular vein graft (Melody valve) in the right ventricular outflow tract, the prosthesis has been modified for surgical valve replacement in pediatric patients with atrioventricular dysfunction with the intention of subsequent valve expansion in the catheterization laboratory as the child grows. Methods and Results A multicenter, retrospective cohort study was performed among patients who underwent atrioventricular valve replacement with Melody valve at 17 participating sites from North America and Europe, including 68 patients with either mitral (n=59) or tricuspid (n=9) replacement at a median age of 8 months (range, 3 days to 13 years). The median size at implantation was 14 mm (range, 9-24 mm). Immediately postoperatively, the valve was competent with low gradients in all patients. Fifteen patients died; 3 patients underwent transplantation. Nineteen patients required reoperation for adverse outcomes, including valve explantation (n=16), left ventricular outflow tract obstruction (n=1), permanent pacemaker implantation (n=1), and paravalvular leak repair (n=1). Twenty-five patients underwent 41 episodes of catheter-based balloon expansion, exhibiting a significant decrease in median gradient ( P<0.001) with no significant increase in grade of regurgitation. Twelve months after implantation, cumulative incidence analysis indicated that 55% of the patients would be expected to be free from death, heart transplantation, structural valve deterioration, or valve replacement. Conclusions The Melody valve is a feasible option for surgical atrioventricular valve replacement in patients with hypoplastic annuli. The prosthesis shows acceptable short-term function and is amenable to catheter-based enlargement as the child grows. However, patients remain at risk for mortality and structural valve deterioration, despite adequate early valvular function. Device design and implantation techniques must be refined to reduce complications and extend durability. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT02505074.

Live born recipient of twin–twin transfusion syndrome with anomalous mitral arcade

“…There are case reports of successfully performed mitral valve replacement from 6 months of age7 8 and mitral valve repair from teenage years 9 15. Recently Pluchinotta et al 16 reported a multicentre study of surgical implantation of the Melody bioprosthetic valve in mitral position for children and infants with intractable mitral disease as early as the neonatal period. The median age and weight at implantation was 8.6 months (range 3 days to 14 years) and 6.6 kg (range not reported), respectively 16.…”

“…Recently Pluchinotta et al 16 reported a multicentre study of surgical implantation of the Melody bioprosthetic valve in mitral position for children and infants with intractable mitral disease as early as the neonatal period. The median age and weight at implantation was 8.6 months (range 3 days to 14 years) and 6.6 kg (range not reported), respectively 16. The experience with this technique is still very limited, and in a preterm neonate weighing only 2 kg there would probably be only a minimal chance ofgain 16…”

“…The median age and weight at implantation was 8.6 months (range 3 days to 14 years) and 6.6 kg (range not reported), respectively 16. The experience with this technique is still very limited, and in a preterm neonate weighing only 2 kg there would probably be only a minimal chance ofgain 16…”

Gradient over Melody valve in left AV valve position reduces with beta blockade

“…There are reports and case series of its use in mitral or tricuspid position. [1][2][3][4][5] The valve diameter is determined by the stent. An increasing gradient over the valve maybe an indication for re-intervention.…”

“…An increasing gradient over the valve maybe an indication for re-intervention. 1,2,4,5 Case report A non-syndromatic baby with AV septal defect was operated at the age of 6 weeks with a weight of 3.5 kg as she showed progressive signs of heart failure. Repair of the left AV valve was difficult due to the lack of tissue, and the child showed severe left AV valve insufficiency post-operatively.…”