Related Experiment Video
Updated: Jan 30, 2026
Standardized Technique of Aortic Valve Re-implantation for Valve-sparing Aortic Root Replacement
Published on: December 11, 2017
A prospective 5-year study of exercise performance following Melody valve implant
Bryant Priromprintr1, Michael J Silka2, Jonathan Rhodes3
1Children's Hospital Los Angeles, University of Southern California, Los Angeles, CA; Lucile Packard Children's Hospital at Stanford, Stanford University Medical Center, Palo Alto, CA.
Insights
The Melody valve implant offers initial exercise capacity gains in congenital heart disease patients, but long-term benefits are limited to specific subgroups, particularly younger patients with pulmonary regurgitation.
Area of Science:
- Cardiology
- Pediatric Cardiology
- Cardiovascular Surgery
Background:
- The long-term impact of Melody valve implantation on exercise capacity in patients with right ventricular outflow tract issues remains unclear.
- Congenital heart disease often necessitates interventions like the Melody valve to address conduit obstruction or insufficiency.
Purpose of the Study:
- To evaluate the sustained, long-term effects of Melody valve implantation on exercise capacity in patients with congenital heart disease.
- To identify patient subgroups that may experience enduring benefits from the Melody valve regarding exercise performance.
Main Methods:
- A prospective study involving 136 patients with congenital heart disease undergoing Melody valve implantation.
- Serial cardiopulmonary exercise testing was performed pre-implant, at 6 months, and annually for up to 5 years post-implantation.
- Subgroup analyses were conducted to identify factors associated with sustained exercise improvements.
Main Results:
- An initial improvement in predicted workload was observed at 6 months post-implantation, but this was not sustained at 5 years for the overall cohort.
- Patients younger than 17 years at implantation and those with pulmonary regurgitation as the primary lesion showed sustained exercise performance improvements.
- Sustained improvements in ventilatory equivalents for O2 and CO2 at the anaerobic threshold were noted, alongside initial but not sustained gains in forced vital capacity.
Conclusions:
- While the Melody valve may offer initial exercise capacity benefits and improved pulmonary function, sustained improvements are not evident in the general patient population.
- The study highlights the importance of patient-specific factors, such as age and primary lesion, in determining long-term exercise outcomes after Melody valve implantation.
- Further cautious appraisal of the cardiovascular benefits is warranted, with a focus on identifying specific patient profiles that benefit long-term.
Background:
The long-term benefits of Melody valve implant for right ventricular outflow tract conduit obstruction or insufficiency on exercise capacity are undefined.
Methods:
As part of the Melody valve clinical trial, 136 patients with congenital heart disease underwent serial cardiopulmonary exercise testing prior to, 6 months after, and annually for up to 5 years postimplant.
Results:
Mean age at Melody valve implantation was 22.4 ± 0.9 years (range 7-53 years). The 95 patients who completed the study protocol provide the basis of this report. An initial improvement in % predicted workload was present at 6 months postimplant; however, at the final (5 year) follow-up, sustained or further improvements in workload were not demonstrated for the entire cohort compared to baseline. By subgroup analysis, age <17 years at implant and pulmonary regurgitation as the primary lesion were variables associated with sustained improvement in exercise performance. There were sustained improvements in the ventilatory equivalents for O2 (minute ventilation/O2 intake, P = .01) and CO2 (minute ventilation/CO2 output, P < .01) at the ventilatory anaerobic threshold at the study conclusion. Improvements in forced vital capacity were also observed during the study but not sustained at the final follow-up.
Conclusions:
A cautious appraisal of the cardiovascular benefits of Melody valve implant on sustained improvements in exercise performance appears warranted. Although the observed changes in pulmonary function suggest improved restrictive lung physiology and more efficient gas exchange, after an initial increase in % predicted performance, neither sustained nor further improvements in exercise performance were observed, except in specific patient subgroups.
Related Concept Videos
01:27Exercise and Muscle Performance
Endurance exercises
Endurance exercises involve running, swimming, or cycling, which require repetitive movements with low force output. When a person engages in endurance exercise, a few noticeable changes occur in their skeletal muscles. For instance, the number of capillaries...
01:045-Number Summary
In a box plot, the minimum and maximum data values represent the lower and upper whiskers in the graph, and the median is designated as the center of the box in the chart. The first quartile and third...
01:16Heart Valves
The AV valves prevent the backflow of blood from the ventricles to the atria during ventricular contraction. These valves function with the assistance of the chordae tendineae and papillary muscles. When the ventricles are relaxed, the chordae tendineae are slack, allowing blood to flow from the atria into the...
01:26Exercise Stress Test
Exercise stress testing, commonly known as a treadmill test, is a noninvasive procedure used to evaluate cardiovascular function and diagnose heart conditions.
Definition
An exercise stress test measures the heart's response to exertion using a treadmill or stationary bicycle. Chest electrodes record the heart's electrical activity through an ECG, and blood pressure is monitored regularly.
Purposes
01:17Exercise and Cardiac Output
Sustained exercise increases the muscles' oxygen demand, which can be...
01:20Exercise and Cardiovascular Response
Light to moderate physical activity initiates a series of interconnected responses in the body. The heart rate modestly increases in anticipation of the workout, followed by widespread vasodilation as oxygen consumption by skeletal muscles increases. This results in decreased peripheral resistance, increased capillary blood flow, and accelerated...