Sophie Malekzadeh-Milani1, Magalie Ladouceur1, Sarah Cohen1, Laurence Iserin1, Younes Boudjemline2. 1. Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France. 2. Centre de référence malformations cardiaques congénitales complexes - M3C, Necker Hospital for Sick Children, Georges-Pompidou European Hospital, Assistance Publique des Hopitaux de Paris, Paediatric Cardiology, Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75270 Paris cedex 06, France. Electronic address: younes.boudjemline@nck.aphp.fr.
Abstract
BACKGROUND: Although widely accepted worldwide, indications for percutaneous valve replacement are limited to treatment of dysfunction of prosthetic conduits inserted in the right ventricular outflow tract (RVOT). There has been little evaluation of the use of the Melody(®) valve for patched non-circular pulmonary pathways. AIM: To evaluate the outcomes of Melody valve insertion in patients with a patched non-circular RVOT. METHODS: We analysed procedural and outcomes data from 34 patients who underwent Melody valve implantation for a non-circular RVOT. RVOT preparation was done in all patients, using different techniques (conventional, Russian doll and/or PA jailing). Melody valve insertion was performed concomitantly in most patients. RESULTS: All procedures were successful. Sixteen patients had complex additional procedures, including the jailing technique (n=5), the Russian doll technique (n=6) and multiple stent implantations (Russian jailing; n=5). The remaining patients were treated using the conventional technique with systematic prestenting. Three early complications occurred: one haemoptysis; one residual RVOT obstruction needing recatheterization 48 hours after percutaneous pulmonary valve implantation; and one stent embolization during advancement of the Ensemble(®) delivery system. The mean follow-up period was 2.6 years postprocedure. There was no stent fracture, migration or embolization. Two patients developed a significant paraprosthetic leak and one received a second Melody valve. CONCLUSIONS: Careful patient selection, balloon sizing and RVOT preparation with prestenting are required to create a safe landing zone for the Melody valve. Short-term follow-up shows excellent results with no stent fracture or migration and appears promising.
BACKGROUND: Although widely accepted worldwide, indications for percutaneous valve replacement are limited to treatment of dysfunction of prosthetic conduits inserted in the right ventricular outflow tract (RVOT). There has been little evaluation of the use of the Melody(®) valve for patched non-circular pulmonary pathways. AIM: To evaluate the outcomes of Melody valve insertion in patients with a patched non-circular RVOT. METHODS: We analysed procedural and outcomes data from 34 patients who underwent Melody valve implantation for a non-circular RVOT. RVOT preparation was done in all patients, using different techniques (conventional, Russian doll and/or PA jailing). Melody valve insertion was performed concomitantly in most patients. RESULTS: All procedures were successful. Sixteen patients had complex additional procedures, including the jailing technique (n=5), the Russian doll technique (n=6) and multiple stent implantations (Russian jailing; n=5). The remaining patients were treated using the conventional technique with systematic prestenting. Three early complications occurred: one haemoptysis; one residual RVOT obstruction needing recatheterization 48 hours after percutaneous pulmonary valve implantation; and one stent embolization during advancement of the Ensemble(®) delivery system. The mean follow-up period was 2.6 years postprocedure. There was no stent fracture, migration or embolization. Two patients developed a significant paraprosthetic leak and one received a second Melody valve. CONCLUSIONS: Careful patient selection, balloon sizing and RVOT preparation with prestenting are required to create a safe landing zone for the Melody valve. Short-term follow-up shows excellent results with no stent fracture or migration and appears promising.
Authors: Arka Chatterjee; Navkaranbir S Bajaj; William S McMahon; Marc G Cribbs; Jeremy S White; Amrita Mukherjee; Mark A Law Journal: J Am Heart Assoc Date: 2017-08-04 Impact factor: 5.501