Abstract 17074: Melody Valve for Surgical Mitral and Tricuspid Valve Replacement in Children With Small Annuli
Introduction: Current options for atrioventricular valve replacement are limited to mechanical valves and fixed diameter bioprostheses, with no options for annuli less than 15 mm diameter. Fixed diameter valves do not allow for expansion with somatic growth, necessitating frequent reoperation for replacement. An externally stented bovine jugular vein graft (Melody valve) has been modified for implantation in children with small annuli, with the potential for expansion as the child grows.
Methods: Pediatric patients at 11 institutions in North America and Europe who underwent surgical implantation of Melody valve in the mitral or tricuspid positions were retrospectively reviewed. Primary outcome measure was early valvular function, whereas secondary outcome measures included valve durability, mortality, and successful valve expansion.
Results: Fifty patients underwent Melody valve implantation in the mitral (n=45) or tricuspid (n=5) position. Diagnosis was congenital MS (n=26), atrioventricular canal (n=18), congenital MR (n= 4), or PA/IVS (n=2). The median age and weight at time of insertion was 1 year (Range: 1 week- 13 years) and 7.1 kilograms (Range: 3.1-52.7 kg). Median size at implantation was 14 mm (Range: 10-20 mm). Echocardiogram within 30 days of insertion demonstrated mild or less regurgitation in 48/50 patients, with a median gradient of 4 mmHg (IQR: 0-5 mmHg). There were 13 deaths, 6 early (within 30 days of implantation) and 7 late (> 30 days). Among survivors, there was clinically significant worsened valvar regurgitation (moderate-severe) at follow up in 6 patients; with median follow up of 13 months (IQR: 5.6-20.4 months). Freedom from valve replacement was 91% at 12 months excluding early deaths. Nineteen patients underwent successful catheter-based valve expansion beyond one month postoperatively for increased gradients.
Conclusions: Surgically implanted Melody valves demonstrate acceptable acute valvular function when used for atrioventricular valve replacement with annular dimensions less than 15 mm. Mortality remains high in acutely ill patients despite adequate postoperative valve function. Long term freedom from replacement is acceptable, and valve expansion is successful at preventing reoperation as a child grows.
Author Disclosures: B.L. Piekarski: None. F.R. Pluchinotta: None. D. Zurakowski: None. J.M. Hammel: None. O. Kretschmar: None. P.J. Chai: None. D.M. McMullan: None. B.A. Mettler: None. P.T. Burch: None. L. Hakami: None. D.B. Meyer: None. F. Jacques: None. A. Frigiola: None. S.M. Emani: None.
- © 2016 by American Heart Association, Inc.