Comparative Outcomes of Pediatric Melody Valve and Mechanical Valve Replacement in the Mitral Position
Anna Olds, BS, Brigitte Kazzi, Matthew Liava'a, MD, Matthew A. Crystal, MD, Alejandro Torres, MD, Damien LaPar, MD, Paul Chai, MD, Emile Bacha, MD, David Kalfa, MD, PhD.
Columbia University Medical Center - NY Presbyterian Hospital, New York, NY, USA.
Objectives: The optimal procedure for pediatric mitral valve replacement (MVR) remains controversial. The objective of this study is to compare outcomes after pediatric Melody and mechanical MVR.
Methods: We retrospectively reviewed all pediatric MVRs at our institution from 2013-2017, including 8 Melody MVRs (7 patients), and 17 mechanical MVRs. We compared outcomes between groups. Valve failure was defined as regurgitation/stenosis ≥moderate, valve thrombosis, or endocarditis.
Results: Patient characteristics and outcomes are presented in Table 1. Melody and mechanical groups had similar preoperative mitral gradients, stenosis/regurgitation, ejection fractions and follow-up durations. Melody patients were younger (p=0.03), with smaller valves implanted (p=0.02). Two mechanical patients died in-hospital, with no Melody patient deaths (p=0.55). Valve failure occurred in three mechanical patients (one valve thrombosis and two valve stenosis ≥moderate) and two Melody patients (one structural degeneration and one endocarditis) (p=1.00). Mitral valve reoperation was needed in one mechanical patient (thrombosis) and in the 2 patients with Melody valve failure (p=0.23). There was no stroke in either group and no need for percutaneous dilations in the Melody group at last follow-up.
Conclusions: Melody MVR can be performed successfully and safely in younger patients with similar rates of valve failure. Melody MVR seems to compare favorably to mechanical MVR in terms of survival, but at the expense of possibly more reoperations. Studies with longer follow-up are warranted.
| Mechanical (n=17) | Melody (n=8) | P-value | |
| Age (years) | 5.62±6.10 | 2.08±1.58 | 0.04 |
| EF (%) | 62.74±15.35 | 64.04±6.32 | 0.84 |
| Valve implant size ≤20mm | 8 (47%) | 8 (100%) | 0.02 |
| Mortality | 2 (12%) | 0 | 0.55 |
| Mitral valve failure | 3 (18%) | 2 (25%) | 1.00 |
| Mitral valve thrombosis | 1 (6%) | 0 | 1.00 |
| MS≥moderate | 2 (12%) | 0 | 0.55 |
| structural degeneration/endocarditis | 0 | 2 (25%) | 0.09 |
| Mitral valve reoperation | 1 (6%) | 2 (25%) | 0.23 |
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