315 One-stage percutaneous Melody pulmonary valve implantation: a single-center experience in 21 consecutive patients

Abstract

Right ventricular outflow tract (RVOT) reconstruction in infancy or childhood leads to lifetime iterative surgery for pulmonary stenosis or regurgitation. Transcatheter pulmonary valve implantation (TPVI) was developed with the aim to reduce the number of reoperations and operative-related morbidity. From 12/2008 to 03/2010, 21 patients were referred to Marie-Lannelongue Hospital for TPVI. Mean age was 24 yrs (11.5–55 yrs), mean weight was 60 kg (20–85 kg). Most of them had a Tetralogy of Fallot variant (n = 12) and 70% had 3 or more previous surgery. RVOT stenosis was predominant in 90% of patients. RVOT reconstruction techniques were: valved conduit (n = 12), non-valved conduit (n = 1), homograft (n = 6), RVOT patch (n = 2). RVOT balloon inflation test was performed only if cardiac CT scan showed coronary arteries located next to the RVOT. Two patients were excluded, 1 because an aorto-pulmonary fistula after Ross operation, and 1 with previous arterial switch because of compression of the reimplanted left coronary artery at RVOT balloon inflation test. Initial stenting and TPVI were performed during the same procedure in 18/19. There was immediate significant decrease in right ventricular systolic pressure (mean 88.6 to 52.2 mmHg), mean RVOT gradient (mean 43.7 to 22 mmHg) and pulmonary regurgitation (grade 2 or more before, none after). One patient with a 16 mm homograft had significant residual stenosis (mean RVOT gradient 45 mmHg) after Melody implantation. All patients were discharged within 2 days. At a mean follow-up of 9.3 months (1 to 24 months) all patients are alive and well and neither Melody valve dysfunction nor stent fracture or migration was noticed. Percutaneous pulmonary valve implantation is a safe alternative to surgery. Our experience suggests that patients with RVOT conduit < 18 mm and those with previous arterial switch operation should be referred to surgery without considering transcatheter procedure.