title: Transcatheter melody valve placement in large diameter bioprostheses and conduits: What is the optimal "Landing zone"?
abstract: OBJECTIVE
  This study sought to elucidate the optimal bioprosthetic valve (BPV) size prior to Melody valve implantation.
  
  
  BACKGROUND
  BPVs provide an ideal "landing zone" for future Melody valve insertion. To guide surgical choice of BPV size, it is important to understand which BPV size can serve consistently as substrates for Melody valve placements.
  
  
  METHODS
  A database of all patients who underwent Melody implantation at UCLA or Kaiser Permanente Los Angeles from 2010 to 2014 was analyzed retrospectively. Patients with an existing BPV were stratified into those with a valve diameter of ≥27 mm or <27 mm.
  
  
  RESULTS
  One hundred and sixty patients underwent catheterization with the intention to implant a Melody valve. Melody valve implantation was performed in the pulmonary position in 52 patients with prior BPVs. The immediate procedural success rate was 100%. Immediately post-Melody, the right ventricular to pulmonary artery gradient was significantly higher in the <27 mm group compared to the ≥27 mm group (14.3±3 vs. 8.6±6.8, P=0.006). There was a significantly shorter time from prior valve replacement to Melody implantation in the <27 mm group. There was one patient in whom transcatheter pulmonary valve implantation was aborted due to inadequate landing zone in the <27 mm group, and no patients in the ≥27 mm group (P=NS).
  
  
  CONCLUSIONS
  The results of this study indicate that 27 and 29 mm BPV provide a superior landing zone for Melody valve implantation with excellent immediate and intermediate term hemodynamic results when compared to smaller BPVs less than 27 mm.
authors.affiliation: Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
authors.forename: Will
authors.initials: W
authors.lastname: Finch
authors.affiliation: Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.|Division of Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Levi
authors.affiliation: Division of Cardiology, Department of Pediatrics, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California.
authors.forename: Morris
authors.initials: M
authors.lastname: Salem
authors.affiliation: Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.
authors.forename: Abbie
authors.initials: A
authors.lastname: Hageman
authors.affiliation: Division of Cardiology, Department of Medicine, David Geffen School of Medicine at UCLA, Ahmanson/UCLA Adult Congenital Heart Disease Center, Los Angeles, California.|Division of Cardiology, Department of Pediatrics, David Geffen School of Medicine at UCLA, Los Angeles, California.
authors.forename: Jamil
authors.initials: J
authors.lastname: Aboulhosn
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D002648:Child; D016208:Databases, Factual; D005260:Female; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000503:physiopathology; D020127:Recovery of Function; D012189:Retrospective Studies; D013997:Time Factors; D016896:Treatment Outcome; D014463:Ultrasonography; D055815:Young Adult
keywords: adult congenital heart disease; transcatheter pulmonary valve implantation