title: Outcomes and safety of transcatheter pulmonary valve replacement in patients with large patched right ventricular outflow tracts.
abstract: BACKGROUND
  Although globally accepted, the indication for implantation of the Melody(®) (Medtronic Inc., Minneapolis, MN, USA) transcatheter pulmonary valve is limited to the treatment of haemodynamically dysfunctional right ventricular outflow tract (RVOT) with right ventricle to pulmonary artery (PA) obstruction. The use of the Melody valve for haemodynamically significant isolated pulmonary regurgitation has not been evaluated.
  
  
  OBJECTIVE
  We evaluated the outcomes of Melody valve insertion in patients with a large patched RVOT.
  
  
  METHODS
  We analysed procedural and short-term outcomes data from 13 patients who underwent Melody valve implantation for a large RVOT with significant pulmonary regurgitation as the primary lesion. RVOT preparation was done in all patients using the Russian dolls technique and/or the PA jailing technique. Melody valve insertion was performed concomitantly in 10 patients and after 1 to 3 months in three patients.
  
  
  RESULTS
  All procedures were successful. The mean follow-up period was 30 ± 4 months after the procedure. There was no incidence of stent fracture, migration or embolization. Only one patient who underwent the jailing technique developed a significant paraprosthetic leak and is scheduled for redilatation of the Melody valve.
  
  
  CONCLUSIONS
  Careful patient selection, balloon sizing and RVOT preparation with prestenting using the Russian dolls technique and/or the PA jailing technique are required to modify the RVOT for transcatheter valve implantation. Short-term follow-up showed competent valves with no stent fracture or migration and appears promising. Wider experience with long-term outcomes may be required to standardize the procedure in such a subset of patients.
authors.affiliation: Centre de Référence Malformations Cardiaques Congénitales Complexes-M3C, Necker Hospital for Sick Children, Assistance Publique des Hôpitaux de Paris, Paediatric Cardiology, Paris, France. younes.boudjemline@nck.aphp.fr
authors.forename: Younes
authors.initials: Y
authors.lastname: Boudjemline
authors.forename: Georgia
authors.initials: G
authors.lastname: Brugada
authors.forename: Isabelle
authors.initials: I
authors.lastname: Van-Aerschot
authors.forename: Mehul
authors.initials: M
authors.lastname: Patel
authors.forename: Adeline
authors.initials: A
authors.lastname: Basquin
authors.forename: Caroline
authors.initials: C
authors.lastname: Bonnet
authors.forename: Antoine
authors.initials: A
authors.lastname: Legendre
authors.forename: Damien
authors.initials: D
authors.lastname: Bonnet
authors.forename: Laurence
authors.initials: L
authors.lastname: Iserin
mesh_terms: D006328:Cardiac Catheterization / Q000379:methods; D005500:Follow-Up Studies; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006352:Heart Ventricles / Q000000981:diagnostic imaging; D006801:Humans; D011446:Prospective Studies; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D011859:Radiography; D015607:Stents; D014694:Ventricular Outflow Obstruction / Q000601:surgery*