Melody vs Mechanical Mitral Valve Replacement in Young Children: A Single-Center Propensity Matched Analysis

To examine outcomes of Melody (Medtronic) vs mechanical mitral valve replacement (MVR) in young children.

We retrospectively reviewed 36 patients aged <2 years who underwent Melody or mechanical MVR between 2005 and 2023. Propensity score matching was performed to account for baseline differences, yielding 2 groups of 12 patients. Transplant-free survival and cumulative incidence of surgical reintervention were compared. Median follow-up time was 2.3 (interquartile range [IQR], 0.4-6.7) years.

Matched groups were similar across baseline parameters. Median age and weight were 5.2 (IQR, 3.5-10.2) months and 6.5 (IQR, 4.9-7.6) kg. In the mechanical group, 4 (36.4%) patients had a pacemaker requirement at discharge, compared with 0 Melody patients (P = .08). Early surgical reinterventions occurred in both groups (16.7% vs 16.7%, P = 1.00). There were 2 early mortalities: 1 in a Melody patient salvaged from mechanical support and 1 in a patient who developed left atrioventricular groove hematoma due to Melody overdilation. There were no differences in transplant-free survival at 5 years (Melody: 66.7%; Mechanical: 66.0%; P = .96) or cumulative incidence of surgical reintervention at 2 years (Melody: 32.2%; Mechanical: 30.3%; P = .3).

Melody MVR offers a suitable alternative to mechanical MVR, with comparable mid-term morbidity and mortality, while avoiding systemic anticoagulation.