Post-market surveillance to detect adverse events associated with Melody® valve implantation.

Published

Journal Article (Review)

OBJECTIVE: The aim of this study was to describe previously unrecognised or under-recognised adverse events associated with Melody® valve implantation. BACKGROUND: In rare diseases and conditions, it is typically not feasible to conduct large-scale safety trials before drug or device approval. Therefore, post-market surveillance mechanisms are necessary to detect rare but potentially serious adverse events. METHODS: We reviewed the United States Food and Drug Administration's Manufacturer and User Facility Device Experience (MAUDE) database and conducted a structured literature review to evaluate adverse events associated with on- and off-label Melody® valve implantation. Adverse events were compared with those described in the prospective Investigational Device Exemption and Post-Market Approval Melody® transcatheter pulmonary valve trials. RESULTS: We identified 631 adverse events associated with "on-label" Melody® valve implants and 84 adverse events associated with "off-label" implants. The most frequent "on-label" adverse events were similar to those described in the prospective trials including stent fracture (n=210) and endocarditis (n=104). Previously unrecognised or under-recognised adverse events included stent fragment embolisation (n=5), device erosion (n=4), immediate post-implant severe valvar insufficiency (n=2), and late coronary compression (n=2 cases at 5 days and 3 months after implantation). Under-recognised adverse events associated with off-label implantation included early valve failure due to insufficiency when implanted in the tricuspid position (n=7) and embolisation with percutaneous implantation in the mitral position (n=5). CONCLUSION: Post-market passive surveillance does not demonstrate a high frequency of previously unrecognised serious adverse events with "on-label" Melody® valve implantation. Further study is needed to evaluate safety of "off-label" uses.

Full Text

Duke Authors

Cited Authors

  • Hill, KD; Goldstein, BH; Angtuaco, MJ; Chu, PY; Fleming, GA

Published Date

  • August 2017

Published In

Volume / Issue

  • 27 / 6

Start / End Page

  • 1090 - 1097

PubMed ID

  • 27829472

Pubmed Central ID

  • 27829472

Electronic International Standard Serial Number (EISSN)

  • 1467-1107

Digital Object Identifier (DOI)

  • 10.1017/S1047951116002092

Language

  • eng

Conference Location

  • England