Melody Valve Implantation Within Freestyle Porcine Aortic Heterograft: Single Center Experience




Kuo, James MD
Feezel, Ashlea


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The Melody transcatheter pulmonary valve has been implanted successfully worldwide since its first implant in 2000. The vast majority of these valves have been implanted in pulmonary homografts. Due to surgeon preference, the most common valve used for pulmonary valve replacement at Cook Children’s is the Medtronic Freestyle stentless porcine aortic heterograft. According to review of the literature and personal contact with representatives at Medtronic, we have the largest cohort of patients with Melody implants within this type of bioprosthetic valve. Retrospective chart review was performed. Between June 2012 and June 2015, 28 Melody valves were implanted; nineteen were placed within the Freestyle valve. The primary indication was pulmonary stenosis in 15 patients, pulmonary insufficiency in 1, and mixed stenosis and insufficiency in 3. All patients had procedural success. Mean right ventricular pressure decreased from 61.7 to 35.6 mmHg. Mean pulmonary valve gradient decreased from 38.1 to 10 mmHg. Mean degree of pulmonary insufficiency (rated 0-4) decreased from 2.3 to 0.7. Two minor procedural adverse events occurred. Three patients had some degree of elevated right ventricular pressure without significant gradient across the Melody valve (two due to moderate peripheral branch pulmonary artery stenosis and one due to pulmonary hypertension, likely secondary to obesity and obstructive sleep apnea). On follow up (2 months to 3 years), Melody valve function has been preserved and no re-interventions have been necessary. The Melody valve can be implanted successfully within a stentless aortic bioprosthesis with good short- and mid-term longevity.