Mid-term outcomes after percutaneous pulmonary valve implantation in complex right ventricular outflow tracts using the “folded” Melody® valve technique

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Percutaneous pulmonary valve implantation (PPVI) using Melody®valve has been validated as a valuable therapeutic option for the management of right ventricular outflow tract (RVOT) dysfunction but remains challenging. The “Folded” modification of the Melody®valve has been reported as a safe and feasible technique in complex RVOT . We sought to evaluate mid-term outcomes in a multicentre cohort who underwent PPVI using the “folded” Melody® valve technique. Patients who underwent PPVI using a Foled Melody®between April 2012 and November 2018 in 6 European tertiary Centerswere retrospectively included. “Folded” Melody® valve technique was successfully performed in 28 patients (mean age = 17.7 ± 10 years old). Indications were: short RVOT and early bifurcation of pulmonary arteries in 12 (42.8%) ( Fig. 1 ) , bioprosthetic valves in 10 (35.7%), coronary arteries proximity in 4 (14.3%) and prevention of retrosternal compression in 2 (7.2%). No complication occurred during procedures. All patients had excellent hemodynamic results. Mean transvalvular peak velocity decreased from 3.8 ± 0.86 m/s before PPVI to 2.4 ± 0.55 m/s in the immediate post-PPVI period. Only 5 patients had trivial pulmonary regurgitation (PR) at discharge. After a median follow up (FU) of 27 ± 17.9 months, all patients were alive, and all, but 3 patients, were free from reintervention: 1 patient (3.5%) developed Melody® valve infective endocarditis 3 months after PPVI and underwent RVOT surgical replacement; Two underwent pulmonary artery stenting 2 and 4 years after of PPVI, but the lesions were not related to the Folded valve. At last FU mean transvalvular peak velocity was 2.6 ± 0.66 m/s and only 5 (17.8%) patients had mild or less PR. No stent fractures were observed. The “folded valve technique” is a safe and feasible modification of the Melody® valve which provides favourable mid-term results without increased rate of valve related complications.