Stented Bovine Jugular Venous Valve (melody Valve) For Hybrid Surgical Mitral And Tricuspid Valve Replacement In Infants And Children: Perioperative And Midterm Outcomes
Ali Ibrahimiye, Ashway House, Joby Varghese, Chris Curzon, Jeffrey Delaney, James Hammel.
Childrens hospital and Medical Center Omaha, Omaha, NE, USA.
Objective(s): There is no perfect option for infants with irreparable atrioventricular valve (AV) disease. We have described a simplified technique to modify and implant a stented bovine valve when standard options fail. This report describes the technique, procedural results, and mid-term outcomes of modified Melody transcatheter pulmonary valves surgically implanted in the mitral and tricuspid position.
Methods: Medical records of patients who underwent hybrid-surgical Melody AV valve implantation from 2014 to 2017 were reviewed.
Results: Twenty-four Melody valves were surgically implanted in 21 patients. Median age was 15 months (range, 0.5-102) and median weight was 8.4kg (range, 2.9-31.1kg). 18 had prior cardiac surgery, 11 with AV valve repair and 4 with previous replacement. Our technique involves suturing a 15mm cuff of ePTFE vascular graft at maximal annular diameter (14-24mm) to the annulus. The valve is shortened by folding the stent at the inlet and outlet, balloon expanded within the cuff and sutured to the cuff at three points. In all patients, the valve was initially competent, with no significant gradient, insufficiency, or perivalvular leak. Impaired pulmonary vein inflow and left ventricular outflow tract obstruction were not identified. No valve migrated. Four patients died and 1 underwent transplantation, none secondary to Melody valve dysfunction. Among survivors, freedom from structural valve deterioration was 96% with median follow-up of 17 months. One valve developed stenosis at 4 months, and was replaced at larger diameter.
Conclusions: The Melody was easily and reproducibly implanted. It demonstrated acceptable mid-term performance in patients with irreparable AV valves.
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