Prestenting for prevention of melody valve stent fractures: A systematic review and meta-analysis.
BACKGROUND
The role of right ventricular outflow tract (RVOT) prestenting in the prevention of Melody valve stent fractures (SFs) is not well defined. We aimed to perform a systematic review and meta-analysis comparing the incidence of SF in Melody valve transcatheter pulmonary implants with and without prestenting.


METHODS
PubMed, EMBASE, and Cochrane Central were searched for studies that reported the incidence of SF in Melody valve transcatheter pulmonary implants stratified by the presence or absence of RVOT prestenting. Subgroup analyses were performed for (1) SF associated with a loss of stent integrity and (2) SF requiring reintervention.


RESULTS
Five studies and 360 patients were included, of whom 207 (57.5%) received prestenting. Follow-up ranged from 15 to 30 months. SF were significantly reduced in the prestenting group (16.7%) when compared to no prestenting (33.5%) (odds-ratio [OR] 0.39; 95%CI 0.22-0.69). Patients who received prestenting also had a lower incidence of (1) SF associated with loss of stent integrity (OR 0.16; 95%CI 0.05-0.48) and (2) SF requiring reintervention (OR 0.15; 95%CI 0.02-0.91).


CONCLUSIONS
Our findings suggest that stenting of the RVOT prior to Melody valve implantation is associated with a reduction in the incidence of SF and fracture-related reinterventions.
Division of Cardiology Department of Medicine, University of Miami, Jackson, Memorial Hospital, Miami, Florida.
Rhanderson
R
Cardoso
Division of Structural Heart Diseases Department of Cardiothoracic Surgery, Lenox Hill Heart and Vascular Institute, New York, New York.
Mohammad
M
Ansari
Department of Cardiology, Ochsner Medical Center, New Orleans, Louisiana.
Daniel
D
Garcia
Division of Cardiology Department of Medicine, University of Miami, Jackson, Memorial Hospital, Miami, Florida.
Satinder
S
Sandhu
Department of Cardiothoracic Surgery, Lenox Hill Heart and Vascular Institute, New York, New York.
Derek
D
Brinster
Division of Cardiology Department of Medicine, McGill University Health Centre, Montreal, Quebec, Canada.
Nicolo
N
Piazza
D000293:Adolescent; D000328:Adult; D000368:Aged; D000800:Angioplasty, Balloon / Q000009:adverse effects / Q000295:instrumentation*; D006328:Cardiac Catheterization / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D016009:Chi-Square Distribution; D002648:Child; D002675:Child, Preschool; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011664:Pulmonary Valve / Q000503:physiopathology; D018570:Risk Assessment; D012307:Risk Factors; D015607:Stents; D016896:Treatment Outcome; D055815:Young Adult
Melody valve; prestenting; right ventricular outflow tract; stent fracture