Key result
Percutaneous pulmonary valve implantation using the folded Melody valve technique resulted in a 90% probability of survival without valve-related reinterventions at 36 months.
Why the study?
The folded valve manually shortens the Melody device for dysfunctional right ventricular outflow tracts requiring a short valved stent, but mid-term multicenter outcomes needed evaluation.
Does percutaneous pulmonary valve implantation using the folded Melody valve technique provide favorable mid-term outcomes in patients with dysfunctional right ventricular outflow tracts?
Cohort (n=49)
Yes
Does percutaneous pulmonary valve implantation using the folded Melody valve technique provide favorable mid-term outcomes in patients with dysfunctional right ventricular outflow tracts?
The folded Melody valve technique is a safe and effective option for percutaneous pulmonary valve implantation in patients with short right ventricular outflow tracts, demonstrating excellent mid-term survival free from reintervention.
Answers are grounded in this paper and cite their sources.
Supports mid-term durability in short RVOTs; hypothesis-generating and should not yet change practice.
BACKGROUND: The folded valve is a manual shortening of the Melody device, which has been validated as a valuable therapeutic option for the management of dysfunctional right ventricular outflow tracts needing a short valved stent. In this article, we aimed to evaluate, in a multicenter cohort, the mid-term outcomes of patients in whom a percutaneous pulmonary valve implantation was performed using the folded valve technique. METHODS: A 2012 to 2018 retrospective multicenter study was performed in 7 European institutions. All patients who benefit from percutaneous pulmonary valve implantation with a folded Melody valve were included. RESULTS: A total of 49 patients (median age, 19 years [range 4–56], 63% male) were included. The primary percutaneous pulmonary valve implantation indication was right ventricular outflow tract stenosis (n=19; 39%), patched native right ventricular outflow tracts were the most common substrate (n=15; 31%). The folded technique was mostly used in short right ventricular outflow tracts (n=28; 57%). Procedural success was 100%. After a median follow-up of 28 months (range, 4–80), folded Melody valve function was comparable to the immediate postimplantation period (mean transvalvular peak velocity=2.6±0.6 versus 2.4±0.6 m/s, P>0.1; only 2 patients had mild pulmonary regurgitation). Incidence rate of valve-related reinterventions was 2.1% per person per year (95% CI, 0.1%–3.9%). The probability of survival without valve-related reinterventions at 36 months was 90% (95% CI, 76%–100%). CONCLUSIONS: The folded Melody valve is a safe technique with favorable mid-term outcomes up to 6.5 years after implantation, comparable with the usual Melody valve implantation procedure. Complications and reinterventions rates were low, making this technique relevant in selected patients.
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Jalal et al. (2021) conducted a cohort in dysfunctional right ventricular outflow tracts (n=49). Percutaneous pulmonary valve implantation using the folded Melody valve technique was evaluated on survival without valve-related reinterventions at 36 months (95% CI 76-100). Percutaneous pulmonary valve implantation using the folded Melody valve technique resulted in a 90% probability of survival without valve-related reinterventions at 36 months.
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