Melody valve implant within failed bioprosthetic valves in the pulmonary position: a multicenter experience.


Journal Article

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.

Full Text

Cited Authors

  • Gillespie, MJ; Rome, JJ; Levi, DS; Williams, RJ; Rhodes, JF; Cheatham, JP; Hellenbrand, WE; Jones, TK; Vincent, JA; Zahn, EM; McElhinney, DB

Published Date

  • December 4, 2012

Published In

Volume / Issue

  • 5 / 6

Start / End Page

  • 862 - 870

PubMed ID

  • 23212395

Pubmed Central ID

  • 23212395

Electronic International Standard Serial Number (EISSN)

  • 1941-7632

International Standard Serial Number (ISSN)

  • 1941-7640

Digital Object Identifier (DOI)

  • 10.1161/circinterventions.112.972216


  • eng