Surgical Melody Mitral Valve: A Paradigm Shift for Infants with Unrepairable Mitral Valve Disease.

BACKGROUND

Melody valve (Melody) for mitral valve replacement (MVR)(MelodyMVR) has been an effective strategy to treat unrepairable mitral valve disease in small children. The purpose of this study is to analyze survival, durability, and complications of MelodyMVR strategy.

METHODS

Patients who underwent MelodyMVR between 2014 and 2023 were included. Transplant-free survival was analyzed with Kaplan-Meier analysis. Fine and Gray sub-distribution method was applied to quantify the cumulative incidence.

RESULTS

Twenty-five patients underwent MelodyMVR. Median age and weight were 6.3 (4.4-15.2) months and 6.36 (4.41-7.57) kg. 60% had congenital mitral valve disease and 52% had dominant mitral regurgitation. The median diameter of the implanted Melody was 16 (14-18) mm. Mortality at 6 months, 1 year, and 5 years was 8.3% (95% CI, 2.2%-29.4%), 12.5% (4.2%-33.9%), and 17.6% (7.0%-40.7%), respectively. Two (8%) hospital survivors required early Melody replacement. Competing risk analysis showed that approximately 50% of patients underwent mechanical MVR by 3.5 years after MelodyMVR. Freedom from bleeding and thrombosis at 4 years was 87.5% (95%CI, 74.2%-100%). Eleven patients underwent mechanical MVR with no mortality. One (9%) required pacemaker implantation after mechanical MVR.

CONCLUSIONS

MelodyMVR provides reasonable early and medium-term survival in small children and a high rate of successful bridge to mechanical MVR. MelodyMVR is associated with minimal pacemaker requirement, bleeding, and thrombosis. Early Melody functional deterioration necessitates early re-MVR, which can be achieved with minimal mortality and morbidity.

Informations de copyright

Copyright © 2024. Published by Elsevier Inc.