Initial Experience with Percutaneous Implantation of the MelodyTM Valve in Brazil

Background: Transcatheter pulmonary valve implantation is an alternative for dysfunctional conduits. We report the first experience with the MelodyTM valve implantation in Brazil. Methods: Patients with significant pulmonary stenosis or significant pulmonary insufficiency in conduits measuring 16 to 22 mm were enrolled. Standardized techniques were employed. The feasibility, safety and efficacy of this procedure were assessed. Results: From December 2013, ten patients (mean age and weight of 16.5 years and 49 kg, respectively) have undergone the procedure with a mean interval of 11.9 ± 8.6 years since the last surgery. Pulmonary insufficiency was an indication for treatment in three patients, pulmonary stenosis in two, and mixed lesion in five. The MelodyTM valve was successfully implanted in all cases. Mean right ventricular systolic pressure and right ventricle/left ventricle ratio decreased from 49.2 ± 15.9 to 35.8 ± 5.7 mmHg and from 0.55 ± 0.18 to 0.39 ± 0.08 mmHg (p < 0.01 for both). Significant residual pulmonary stenosis or pulmonary insufficiency was not observed. One patient had a contained conduit tear requiring a covered stent and a second valve implantation. All patients were discharged within 72 hours. The valves were properly functioning in a mean follow-up of 4.1 ± 2.2 months with no complications. Conclusions: Transcatheter MelodyTM valve implantation was feasible, safe and effective in our environment and in line with previously published data. Although more patients and a longer follow-up are required, cost-effectiveness studies should be performed for possible incorporation in the Brazilian public health system. DESCRIPTORS: Pulmonary valve stenosis. Pulmonary valve insufficiency. Tetralogy of Fallot. Prostheses and implants. 1 Instituto Dante Pazzanese de Cardiologia, São Paulo, SP, Brazil. 2 Hospital do Coração Associação do Sanatório Sírio, São Paulo, SP, Brazil. 3 Instituto de Cardiologia, Porto Alegre, RS, Brazil. 4 Nationwide Children’s Hospital, Ohio, United States. Correspondence to: Marcelo Silva Ribeiro. Instituto Dante Pazzanese de Cardiologia – Avenida Dr. Dante Pazzanese, 500 – Vila Mariana – CEP: 04012-180 – São Paulo, SP, Brazil E-mail: marcelosribeiro@gmail.com Received on: 06/01/2014 • Accepted on: 08/03/2014 Original Article