Percutaneous Melody™ Valve Implantation in Patients with Dysfunctional Right Ventricular Outflow Tract

Background: Percutaneous pulmonary valve implantation is currently considered the treatment of choice in selected cases with previous history of congenital heart disease that present with symptoms of right ventricular outflow tract (RVOT) obstruction and/or pulmonary regurgitation. Objective: The aim of this study was to describe the initial experience with the Melody™ pulmonary valve in a tertiary care center of Argentina. Methods: All patients treated with the Melody™ valve from August 2013 to May 2016 (n=8) were included in the study. Results: Mean age was 25±18 years (range: 13-69), and weight was 56.9±9.3 kg (range: 45-73). Baseline heart diseases were aortic stenosis corrected with the Ross procedure (n=3), truncus arteriosus (n=2), tetralogy of Fallot (n=2) and transposition of the great vessels (n=1). Two patients had severe pulmonary regurgitation, 2 severe stenosis, and 4 double lesion. The number of stents prior to implantation was 2.1±0.64. The overall success rate was 100%. The right ventricular outflow tract gradient and the ratio between right ventricular pressure and systemic pressure diminished significantly (from 57.3±30 to 15±4.2 mmHg, and from 0.67±0.22 to 0.32±0.04, respectively) (p <0.001) with only trace or absent pulmonary regurgitation. No complications were observed. At a mean follow up of 14.3±10.3 months (range 34-1), all patients remained asymptomatic and free from significant pulmonary regurgitation. Conclusion: In our preliminary experience, the Melody™ pulmonary valve was found to be safe and effective, showing drastic right ventricular outflow tract gradient reduction, absence of significant regurgitation and marked clinical improvement. These findings confirm the excellent performance of this valve in patients with dysfunctional right ventricular outflow tract.