The Melody Valve in Small Children undergoing First Mitral Valve Replacement: Better than Mechanical?
Annals of Thoracic Surgery Short Reports(2024)
摘要
BACKGROUND
In small children with left atrioventricular valve dysfunction, valve repair is preferred but some will require valve replacement. No prosthetic valve has growth potential; bioprostheses have poor durability; and mechanical prostheses have high rates of thromboembolic and hemorrhagic complications. We reviewed our experience with a modified bovine jugular vein valve designed for use in the right ventricular outflow tract (Melody ValveTM) and compared this with contemporary mechanical valve replacement.
METHODS
We reviewed outcomes of all left-sided atrioventricular valve replacements (AVVR) performed between 1/2017 and 4/2023 on patients with biventricular circulation less than 5 years old at time of surgery, n=19. We compared mortality and major morbidity outcomes between mechanical AVVR (mAVVR, n=14) and Melody AVVR (MAVVR, n=5).
RESULTS
MAVVR was performed on younger and smaller patients (5.7+/- 4.2 vs. 28.4+/- 22.3 months, p=.002; 6+/- 1.7 vs.10+/- 5.1 kg, p=.01). There were 2 early and 1 late death in the mAVVR group, and none in the MAVVR group. There was a trend towards more hemorrhagic and neurologic complications in the mAVVR group (p=0.1, 0.28 respectively).
CONCLUSIONS
In this small series, despite its use in younger and smaller patients our preliminary experience with the Melody valve compares favorably with our contemporaneous outcomes with mechanical prostheses by way of simpler anticoagulation management with a trend towards better overall outcomes.
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