Stented bovine jugular vein graft (Melody valve) for surgical mitral valve replacement in infants and children.

Abstract

OBJECTIVE:

The options for mitral valve replacement in children with irreparable mitral valve disease have been limited to fixed-diameter prostheses that do not accommodate for somatic growth. We have modified an externally stented bovine jugular vein graft (Melody valve) for implantation in this cohort. Because it is not a fixed-diameter prosthesis, we hypothesized that the valve can be expanded in the catheterization laboratory as the child grows.

METHODS:

The medical records of patients who had undergone Melody valve implantation in the mitral or left atrioventricular valve position from 2010 to 2013 were reviewed.

RESULTS:

Eleven patients had undergone Melody valve implantation at a median age of 7 months (range, 2-28). The techniques of valve modification and implantation included stent shortening, adding a pericardial sewing cuff, intraoperative balloon expansion, and fixation of the distal stent to the inferior left ventricle wall. The valve was competent, with a low gradient acutely postoperatively in all patients. One patient died, and one required permanent pacemaker implantation. One patient developed valve dysfunction and required explantation. Two patients without a pericardial sewing cuff developed paravalvular leaks. One patient who had not undergone distal stent fixation developed left ventricular outflow tract obstruction. Three patients who had undergone subsequent catheter-based balloon expansion of the valve have continued to demonstrate acceptable valvular function.

CONCLUSIONS:

The Melody valve has demonstrated acceptable short-term function. Implantation techniques to prevent left ventricular outflow tract obstruction (suture fixation of the distal stent) and paravalvular leaks (the addition of a pericardial cuff) should be considered. The Melody valve can be percutaneously expanded as the child grows.

• Authors: Luis G Quiñonez, Roger Breitbart, Wayne Tworetsky, James E Lock, Audrey C Marshall, Sitaram M Emani
• Journal: The Journal of thoracic and cardiovascular surgery (J Thorac Cardiovasc Surg) Vol. 148 Issue 4 Pg. 1443-9 (Oct 2014) ISSN: 1097-685X [Electronic] United States
• PMID: 24332108 (Publication Type: Journal Article)
• Copyright: Copyright © 2014 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

Topics

• Animals
• Bioprosthesis
• Cattle
• Child, Preschool
• Female
• Heart Defects, Congenital (surgery)
• Heart Valve Prosthesis
• Heart Valve Prosthesis Implantation (methods)
• Humans
• Infant
• Jugular Veins (surgery)
• Male
• Mitral Valve (abnormalities, surgery)
• Mitral Valve Insufficiency (congenital, surgery)
• Retrospective Studies
• Stents
• Treatment Outcome