Brian H Morray1, Doff B McElhinney2, Younes Boudjemline2, Marc Gewillig2, Dennis W Kim2, Elena K Grant2, Martin L Bocks2, Mary H Martin2, Aimee K Armstrong2, Darren Berman2, Saar Danon2, Mark Hoyer2, Jeffrey W Delaney2, Henri Justino2, Athar M Qureshi2, Jeffery J Meadows2, Thomas K Jones2. 1. From the Division of Cardiology, Seattle Children's Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor (M.L.B.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Department of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH (A.K.A., D.B.); Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO (S.D.); Division of Pediatric Cardiology, Riley Hospital for Children, Indianapolis, IN (M.H.); Division of Pediatric Cardiology, Department of Pediatrics, University of Nebraska, Children's Hospital and Medical Center, Omaha (J.W.D.); Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston (H.J., A.M.Q.); and Division of Cardiology, UCSF Benioff Children's Hospital, University of California, San Francisco (J.J.M.). brian.morray@seattlechildrens.org. 2. From the Division of Cardiology, Seattle Children's Hospital, University of Washington (B.H.M., T.K.J.); Department of Cardiothoracic Surgery, Lucille Packard Children's Hospital at Stanford, Palo Alto, CA (D.B.M.); Necker Enfants Malades Hospital, Paris, France (Y.B.); Pediatric and Congenital Cardiology, UZ Leuven, Belgium (M.G.); Division of Pediatric Cardiology, Children's Healthcare of Atlanta, Emory University, Atlanta, GA (D.W.K., E.K.G.); Division of Pediatric Cardiology, Department of Pediatrics and Communicable Diseases, University of Michigan C.S. Mott Children's Hospital Congenital Heart Center, Ann Arbor (M.L.B.); Division of Cardiology, Department of Pediatrics, University of Utah, Salt Lake City (M.H.M.); Department of Pediatric Cardiology, Nationwide Children's Hospital, Columbus, OH (A.K.A., D.B.); Division of Pediatric Cardiology, Washington University School of Medicine, St. Louis, MO (S.D.); Division of Pediatric Cardiology, Riley Hospital for Children, Indianapolis, IN (M.H.); Division of Pediatric Cardiology, Department of Pediatrics, University of Nebraska, Children's Hospital and Medical Center, Omaha (J.W.D.); Lillie Frank Abercrombie Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston (H.J., A.M.Q.); and Division of Cardiology, UCSF Benioff Children's Hospital, University of California, San Francisco (J.J.M.).
Abstract
BACKGROUND: Follow-up of transcatheter pulmonary valve replacement (TPVR) with the Melody valve has demonstrated good short-term and long-term outcomes, but there are no published studies focused on valve performance in the Contegra bovine jugular vein conduit. METHODS AND RESULTS: This is a retrospective, multicenter study of the short- and intermediate-term outcomes of Melody TPVR within the Contegra conduit in the right ventricle to pulmonary artery position. Data from 13 centers were included in the analysis. During the study period, 136 patients underwent 139 catheterizations for attempted Melody TPVR with a median follow-up of 3 years (1 day to 9.1 years). Of the 136 patients, 117 underwent successful Melody TPVR. Two patients underwent a second Melody TPVR. The majority of patients underwent placement of ≥1 stents before transcatheter pulmonary valve implantation. There was a significant reduction in peak conduit pressure gradient acutely after transcatheter pulmonary valve implantation (39 versus 10 mm Hg; P<0.001). At most recent follow-up, the maximum pulmonary valve gradient by echocardiogram remained significantly reduced relative to prevalve implant measurements (65.9 versus 27.3 mm Hg; P<0.001). The incidence of Melody transcatheter pulmonary valve stent fracture (3.4%) and infectious endocarditis (4.3%) were both low. Serious adverse events occurred in 3 patients. CONCLUSIONS: Melody TPVR in Contegra conduits is safe and effective and can be performed in a wide range of conduit sizes with preserved valve function and low incidence of stent fracture and endocarditis.
BACKGROUND: Follow-up of transcatheter pulmonary valve replacement (TPVR) with the Melody valve has demonstrated good short-term and long-term outcomes, but there are no published studies focused on valve performance in the Contegra bovine jugular vein conduit. METHODS AND RESULTS: This is a retrospective, multicenter study of the short- and intermediate-term outcomes of Melody TPVR within the Contegra conduit in the right ventricle to pulmonary artery position. Data from 13 centers were included in the analysis. During the study period, 136 patients underwent 139 catheterizations for attempted Melody TPVR with a median follow-up of 3 years (1 day to 9.1 years). Of the 136 patients, 117 underwent successful Melody TPVR. Two patients underwent a second Melody TPVR. The majority of patients underwent placement of ≥1 stents before transcatheter pulmonary valve implantation. There was a significant reduction in peak conduit pressure gradient acutely after transcatheter pulmonary valve implantation (39 versus 10 mm Hg; P<0.001). At most recent follow-up, the maximum pulmonary valve gradient by echocardiogram remained significantly reduced relative to prevalve implant measurements (65.9 versus 27.3 mm Hg; P<0.001). The incidence of Melody transcatheter pulmonary valve stent fracture (3.4%) and infectious endocarditis (4.3%) were both low. Serious adverse events occurred in 3 patients. CONCLUSIONS: Melody TPVR in Contegra conduits is safe and effective and can be performed in a wide range of conduit sizes with preserved valve function and low incidence of stent fracture and endocarditis.