Abstract 13122: Transvenous Implantation of the Melody Valve for Bioprosthetic Mitral and Tricuspid Valve Dysfunction: a Case Series
Background Open surgery for replacement of degenerated bioprosthetic valves is associated with substantial risk for morbidity and mortality. We report the results of percutaneous, transvenous, valve-in-valve therapy using a bovine jugular prosthesis (Melody valve, Medtronic, Minneapolis, MN) for patients with degenerated mitral and tricuspid bioprosthetic valves.
Methods and results Ten patients (median age 74 years; 5 males) with degenerated mitral (n=5) or tricuspid (n=5) bioprosthetic valves underwent transvenous valve-in-valve implantation of the Melody valve. Mean STS mortality score for the mitral valve implantations was 15.2±6.3%. Two tricuspid patients were >18 years of age; both had multiple previous sternotomies. Size of the dysfunctional valves ranged 27 to 29 mm in the mitral position and 25 to 33 mm in the tricuspid position. At baseline, all patients had valve obstruction (mean bioprosthetic diastolic inflow gradient ≥5 mmHg); 4 mitral plus 3 tricuspid patients had at least moderate bioprosthetic valve regurgitation. All underwent successful implantation of a 22 mm Melody valve in the dysfunctional valve. Mean inflow gradient decreased from 13.4±3.0 to 5.2±2.3 mmHg for the mitral implants (p=0.02 by paired t-test) and from 11.4±5.1 to 6.2±2.6 mmHg (p=0.08) for the tricuspid implants. In the 7 patients with significant baseline bioprosthetic regurgitation, post-implant regurgitation was trace to mild in 6 patients and mild-moderate in 1 patient. No peri-procedural deaths, myocardial infarctions, strokes, or valve embolizations occurred. Vascular complications occurred in 3 patients, requiring endovascular (n=2) or surgical (n=1) intervention. Functional class improved from a mean New York Heart Association Class III to Class II in 9 of the 10 patients (p>0.004 by Wilcoxon rank-sum test). One patient was dismissed to palliative care.
Discussion Percutaneous, transvenous valve-in-valve implantation of the Melody valve in the mitral or tricuspid position is a feasible procedure that can safely and successfully treat bioprosthetic valve dysfunction. Longer surveillance is necessary to determine if valve-in-valve therapy can significantly extend the life of biologic valves without the need for open cardiac surgery.
- © 2012 by American Heart Association, Inc.