Valve Longevity And Predictors Of Valve Failure Following Melody Atrioventricular Valve Replacement
James M. Hammel1, Samantha Gilg2, Christopher Curzon2, Ali Ibrahimiye2, David Danford2, Jeffrey Delaney2.
1Helen DeVos Children's Hospital, Grand Rapids, MI, USA, 2Children's Hospital, Omaha, NE, USA.
Objective(s):
Limited options for infant-sized valve prostheses have lead to off-label implantation of the Melody stented bovine jugular transcatheter pulmonary valve in the atrioventricular position. The expected durability of the Melody valve at systemic pressure, and the factors leading to early valve failure, are not yet well understood.
Methods:
Single-center retrospective analysis of patients having Melody atrioventricular valve replacement between 2014 and 2021. All valves were implanted by PTFE cuff suturing to the valve annulus followed by Melody valve deployment over an angioplasty balloon. The primary outcome was months to valve failure, defined as valve reintervention, with data censored at patient death or study end. Univariate associations of independent variables with the primary outcome were evaluated using Kaplan-Meier product-limit estimation with log-rank testing.
Results:
37 Melody valves were implanted in 26 patients during the study period, at median age of 17 months and weight of 8.5 kg. Median time to valve reintervention was 31 months. 85% of valves were replaced for stenosis +/- insufficiency; none for pure insufficiency. Systemic position did not predict failure. Young age, small size, single ventricle physiology, and implant diameter < 20 mm predicted earlier valve failure. Ratio of implant diameter to normal valve size of <1.2 or >1.35 was associated with earlier failure. Among patients >12 months of age, mean time to failure was 61.8 +/- 9.9 months.
Conclusions:
The Melody valve gives a useful period of replacement atrioventricular function in infants and children. Implant longevity in infants remains challenging. Extreme oversizing is unhelpful.
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