Abstract 16393: Percutaneous Implantation of the Medtronic Melody Valve in the Tricuspid Position — A Multi-Institutional Multi-National Report
Background: Percutaneous transcatheter valve replacement in both the pulmonic and aortic positions has been well described. The Medtronic Melody Transcatheter Pulmonary Valve (TPV) has recently been approved for use in the U.S. for treatment of dysfunctional right ventricular conduits. We are not aware of any series describing the use of this emerging technology in the setting of tricuspid valve dysfunction.
Methods: Institutions with significant experience with the TPV were approached to collect data where this valve had been implanted on ‘off-label’ humanitarian grounds, in the tricuspid position. Clinical and procedural data were gathered. Procedural success was defined as successful percutaneous TPV implantation without the need for explantation during that admission.
Results: A total of 13 cases, aged 9 to 64 years (4 male), were identified. All patients had been previously operated upon with 9 having previously placed bioprosthetic tricuspid valves and 4 having had RA-RV valved conduits in the setting of complex congenital disease. All patients had severe tricuspid stenosis, regurgitation or mixed disease in association with significant hemodynamic compromise and perceived excessive surgical risk. Procedural success was achieved in all cases. Median procedural and fluoroscopy times were 120 and 28 minutes (range 54–251 and 8 – 74), respectively. Mean tricuspid valve gradient fell from 12 to 3 mmHg (p<0.01) and no patient had more than mild tricuspid regurgitation after TPV implant. Major adverse events included 1 case of 3rd degree AV block requiring pacemaker insertion and 1 case of TPV endocarditis discovered 2 months post-implantation necessitating valve removal. One patient with pre-procedural multi-organ failure did not improve after technically successful TPV implant and died 17 days after the procedure. The remaining patients are alive with functioning TPV in the tricuspid position.
Conclusions: In selected cases, TPV insertion in the tricuspid position in previously operated patients can relieve stenosis and/or regurgitation and delay re-operation. More follow-up and a broader experience are needed to determine the ultimate role of this therapy.
- © 2010 by American Heart Association, Inc.