Initial Experience with Elective Perventricular Melody Valve Placement in Small Patients

Area of Science:

• Cardiology
• Pediatric Cardiac Surgery
• Interventional Cardiology

Background:

• Perventricular Melody valve placement is typically a bailout or alternative right ventricular outflow tract (RVOT) approach for patients over 30 kg.
• Limited data exists on its use in smaller pediatric populations or those with challenging venous access.

Purpose of the Study:

• To evaluate the safety and feasibility of elective perventricular Melody valve replacement in patients weighing less than 30 kg and those with limited venous access.
• To assess technical success rates and identify potential complications associated with this approach in a pediatric cohort.

Main Methods:

• Retrospective analysis of patients under 30 kg undergoing elective hybrid pulmonary valve replacement via a perventricular subcostal approach without sternotomy.
• Sheath introduction through the diaphragmatic surface of the right ventricle.
• Review of diagnoses (tetralogy of Fallot, truncus arteriosus), patient weight, and conduit/patch types.

Main Results:

• 100% technical success in placing the Melody valve in 5 patients (mean weight 16.2 kg).
• No patient required conversion to cardiopulmonary bypass.
• Complications included stent migration in two patients (without sequela) and tricuspid valve chordal injury in one patient (where transesophageal echocardiogram was not used).

Conclusions:

• The perventricular Melody valve placement technique is feasible and safe in small-sized pediatric patients.
• Careful advancement of the valve delivery system is crucial to prevent stent migration.
• Transesophageal echocardiogram (TEE) assistance is recommended to minimize the risk of tricuspid valve injury.