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Risk of infective endocarditis after hybrid melody mitral valve replacement in infants: the French experience
Paul Padovani1,2, Zakaria Jalal3,4,5, Virginie Fouilloux6
1Department of Pediatric Cardiology and Pediatric Cardiac Surgery, FHU PRECICARE, Nantes Université, CHU Nantes, Nantes, France.
Insights
Melody mitral valve replacement in infants shows promise for small annuli but carries a high risk of late infective endocarditis. Further research is needed to address this complication in pediatric cardiac surgery.
Area of Science:
- Pediatric Cardiac Surgery
- Interventional Cardiology
- Biomaterials in Medicine
Background:
- Surgical management of mitral valve disease in infants under one year old presents significant challenges.
- The Melody valve, a transcatheter valve, offers a potential solution for small mitral valve annuli.
Purpose of the Study:
- To review the French experience with Melody mitral valve replacement in critically ill infants.
- To evaluate the safety and efficacy of the Melody valve in this pediatric population.
Main Methods:
- A retrospective cohort study was conducted.
- Data from infants undergoing Melody mitral valve replacement were analyzed.
Main Results:
- Seven infants with severe mitral valve regurgitation or mixed valve disease received the Melody valve.
- The procedure resulted in a competent valve with a low gradient.
- One early death occurred due to stroke; 50% of discharged patients were readmitted for suspected infective endocarditis, with two subsequent deaths.
Conclusions:
- Melody mitral valve replacement can be a viable alternative to mechanical valves in selected infants with small mitral valve annuli.
- A significant risk of late infective endocarditis was observed, necessitating further investigation and management strategies.
Objectives:
Surgical management of mitral valve disease is challenging in infants <1 year old. We aimed at reviewing the French experience with Melody mitral valve replacement in critically ill infants.
Methods:
A retrospective cohort study reporting the French experience with Melody mitral valve replacement.
Results:
Seven symptomatic infants [complete atrioventricular septal defect (n = 4, Down syndrome: n = 3), hammock valve (n = 3)] underwent Melody mitral valve replacement [age: 3 months (28 days to 8 months), weight: 4.3 kg (3.2-6.4 kg)] because of severe mitral valve regurgitation (6) or mixed valve disease (1) and 14 mm (11-16 mm) mitral valve annulus. In 2 patients whose valve was felt irreparable, Melody mitral valve replacement was performed straightaway. The others underwent 2 (1-3) previous attempts of valve repair; 3 were on extracorporeal membrane oxygenation. Melody mitral valve replacement led to competent valve and low gradient [3 mmHg, (1-4 mmHg)]. One patient died 3 days post-implant from extracorporeal membrane oxygenation-related stroke. Of the 6 discharged home patients, 3 (50%) were readmitted for a definite diagnosis (1) or high suspicion (2) of infective endocarditis, of which 2 died. Over the follow-up, 1 underwent balloon expansions of the valve at 9- and 16-months post-implant, and mechanical mitral valve replacement at 2 years; another is currently planned for transcatheter Melody valve dilation.
Conclusions:
Melody mitral valve replacement may be considered in selected infants with small mitral valve annulus as an alternative to mechanical mitral valve replacement. Our experience highlights a high-risk of late infective endocarditis that deserves further consideration.
