title: Melody valve implant within failed bioprosthetic valves in the pulmonary position: a multicenter experience.
abstract: BACKGROUND
  Transcatheter pulmonary valve implantation using the Melody valve has emerged as an important therapy for the treatment of postoperative right ventricular outflow tract dysfunction. Melody-in-bioprosthetic valves (BPV) is currently considered an off-label indication. We review the combined experience with transcatheter pulmonary valve implantation within BPVs from 8 centers in the United States and discuss technical aspects of the Melody-in-BPV procedure.
  
  
  RESULTS
  A total of 104 patients underwent Melody-in-BPV in the pulmonary position at 8 US centers from April 2007 to January 2012. Ten different types of BPVs were intervened on, with Melody valve implantation at the intended site in all patients. Following Melody valve implant, the peak right ventricle-to-pulmonary artery gradient decreased from 38.7 ± 16.3 to 10.9 ± 6.7 mm Hg (P<0.001), and the right ventricular systolic pressure fell from 71.6 ± 21.7 to 46.7 ± 15.9 mm Hg (P<0.001). There was no serious procedural morbidity, and no deaths related to the catheterization or implant. At a median follow-up of 12 months (1-46 months), no patients had more than mild regurgitation, and 4 had a mean right ventricular outflow tract gradient ≥30 mm Hg. During follow-up, there were 2 stent fractures, 3 cases of endocarditis (2 managed with surgical explant), and 2 deaths that were unrelated to the Melody valve.
  
  
  CONCLUSIONS
  Transcatheter pulmonary valve implantation using the Melody valve within BPVs can be accomplished with a high rate of success, low procedure-related morbidity and mortality, and excellent short-term results. The findings of this preliminary multicenter experience suggest that the Melody valve is an effective transcatheter treatment option for failed BPVs.
authors.affiliation: Division of Cardiology, Children's Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, USA. gillespie@email.chop.edu
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Gillespie
authors.forename: Jonathan J
authors.initials: JJ
authors.lastname: Rome
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Levi
authors.forename: Ryan J
authors.initials: RJ
authors.lastname: Williams
authors.forename: John F
authors.initials: JF
authors.lastname: Rhodes
authors.forename: John P
authors.initials: JP
authors.lastname: Cheatham
authors.forename: William E
authors.initials: WE
authors.lastname: Hellenbrand
authors.forename: Thomas K
authors.initials: TK
authors.lastname: Jones
authors.forename: Julie A
authors.initials: JA
authors.lastname: Vincent
authors.forename: Evan M
authors.initials: EM
authors.lastname: Zahn
authors.forename: Doff B
authors.initials: DB
authors.lastname: McElhinney
mesh_terms: D000293:Adolescent; D000328:Adult; D062186:Arterial Pressure; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation*; D002648:Child; D002675:Child, Preschool; D004696:Endocarditis / Q000209:etiology / Q000503:physiopathology / Q000601:surgery; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011651:Pulmonary Artery / Q000503:physiopathology; D011664:Pulmonary Valve / Q000503:physiopathology / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000209:etiology / Q000503:physiopathology; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014481:United States; D016278:Ventricular Function, Right; D017725:Ventricular Pressure; D055815:Young Adult