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Melody valve implant within failed bioprosthetic valves in the pulmonary position: a multicenter experience.
Circ Cardiovasc Interv. 2012 Dec; 5(6):862-70.CC

Abstract

BACKGROUND

Transcatheter pulmonary valve implantation using the Melody valve has emerged as an important therapy for the treatment of postoperative right ventricular outflow tract dysfunction. Melody-in-bioprosthetic valves (BPV) is currently considered an off-label indication. We review the combined experience with transcatheter pulmonary valve implantation within BPVs from 8 centers in the United States and discuss technical aspects of the Melody-in-BPV procedure.

METHODS AND RESULTS

A total of 104 patients underwent Melody-in-BPV in the pulmonary position at 8 US centers from April 2007 to January 2012. Ten different types of BPVs were intervened on, with Melody valve implantation at the intended site in all patients. Following Melody valve implant, the peak right ventricle-to-pulmonary artery gradient decreased from 38.7 ± 16.3 to 10.9 ± 6.7 mm Hg (P<0.001), and the right ventricular systolic pressure fell from 71.6 ± 21.7 to 46.7 ± 15.9 mm Hg (P<0.001). There was no serious procedural morbidity, and no deaths related to the catheterization or implant. At a median follow-up of 12 months (1-46 months), no patients had more than mild regurgitation, and 4 had a mean right ventricular outflow tract gradient ≥30 mm Hg. During follow-up, there were 2 stent fractures, 3 cases of endocarditis (2 managed with surgical explant), and 2 deaths that were unrelated to the Melody valve.

CONCLUSIONS

Transcatheter pulmonary valve implantation using the Melody valve within BPVs can be accomplished with a high rate of success, low procedure-related morbidity and mortality, and excellent short-term results. The findings of this preliminary multicenter experience suggest that the Melody valve is an effective transcatheter treatment option for failed BPVs.

Authors+Show Affiliations

Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. gillespie@email.chop.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

23212395

Citation

Gillespie, Matthew J., et al. "Melody Valve Implant Within Failed Bioprosthetic Valves in the Pulmonary Position: a Multicenter Experience." Circulation. Cardiovascular Interventions, vol. 5, no. 6, 2012, pp. 862-70.
Gillespie MJ, Rome JJ, Levi DS, et al. Melody valve implant within failed bioprosthetic valves in the pulmonary position: a multicenter experience. Circ Cardiovasc Interv. 2012;5(6):862-70.
Gillespie, M. J., Rome, J. J., Levi, D. S., Williams, R. J., Rhodes, J. F., Cheatham, J. P., Hellenbrand, W. E., Jones, T. K., Vincent, J. A., Zahn, E. M., & McElhinney, D. B. (2012). Melody valve implant within failed bioprosthetic valves in the pulmonary position: a multicenter experience. Circulation. Cardiovascular Interventions, 5(6), 862-70. https://doi.org/10.1161/CIRCINTERVENTIONS.112.972216
Gillespie MJ, et al. Melody Valve Implant Within Failed Bioprosthetic Valves in the Pulmonary Position: a Multicenter Experience. Circ Cardiovasc Interv. 2012;5(6):862-70. PubMed PMID: 23212395.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Melody valve implant within failed bioprosthetic valves in the pulmonary position: a multicenter experience. AU - Gillespie,Matthew J, AU - Rome,Jonathan J, AU - Levi,Daniel S, AU - Williams,Ryan J, AU - Rhodes,John F, AU - Cheatham,John P, AU - Hellenbrand,William E, AU - Jones,Thomas K, AU - Vincent,Julie A, AU - Zahn,Evan M, AU - McElhinney,Doff B, Y1 - 2012/12/04/ PY - 2012/12/6/entrez PY - 2012/12/6/pubmed PY - 2013/6/5/medline SP - 862 EP - 70 JF - Circulation. Cardiovascular interventions JO - Circ Cardiovasc Interv VL - 5 IS - 6 N2 - BACKGROUND: Transcatheter pulmonary valve implantation using the Melody valve has emerged as an important therapy for the treatment of postoperative right ventricular outflow tract dysfunction. Melody-in-bioprosthetic valves (BPV) is currently considered an off-label indication. We review the combined experience with transcatheter pulmonary valve implantation within BPVs from 8 centers in the United States and discuss technical aspects of the Melody-in-BPV procedure. METHODS AND RESULTS: A total of 104 patients underwent Melody-in-BPV in the pulmonary position at 8 US centers from April 2007 to January 2012. Ten different types of BPVs were intervened on, with Melody valve implantation at the intended site in all patients. Following Melody valve implant, the peak right ventricle-to-pulmonary artery gradient decreased from 38.7 ± 16.3 to 10.9 ± 6.7 mm Hg (P<0.001), and the right ventricular systolic pressure fell from 71.6 ± 21.7 to 46.7 ± 15.9 mm Hg (P<0.001). There was no serious procedural morbidity, and no deaths related to the catheterization or implant. At a median follow-up of 12 months (1-46 months), no patients had more than mild regurgitation, and 4 had a mean right ventricular outflow tract gradient ≥30 mm Hg. During follow-up, there were 2 stent fractures, 3 cases of endocarditis (2 managed with surgical explant), and 2 deaths that were unrelated to the Melody valve. CONCLUSIONS: Transcatheter pulmonary valve implantation using the Melody valve within BPVs can be accomplished with a high rate of success, low procedure-related morbidity and mortality, and excellent short-term results. The findings of this preliminary multicenter experience suggest that the Melody valve is an effective transcatheter treatment option for failed BPVs. SN - 1941-7632 UR - https://www.unboundmedicine.com/medline/citation/23212395/Melody_valve_implant_within_failed_bioprosthetic_valves_in_the_pulmonary_position:_a_multicenter_experience_ L2 - https://www.ahajournals.org/doi/10.1161/CIRCINTERVENTIONS.112.972216?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -