Melody transcatheter valve: Histopathology and clinical implications of nine explanted devices

Schneider, Heike; Vogt, Manfred; Boekenkamp, Regina; Hoerer, Juergen; Eicken, Andreas; Foth, Rudi; Kriebel, Thomas; Paul, Thomas; Sigler, Matthias

doi:10.1016/j.ijcard.2015.04.067

Cited by 21 publications

(17 citation statements)

References 23 publications

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“…Histopathologic studies have confirmed the same finding,50 as have other reports,14, 19 concluding that insufficiency is a rare manifestation of Melody valve IE.…”

Section: Discussionsupporting

confidence: 82%

“…In the same study,50 a thrombotic material was found at the basis of the leaflets or at the graft wall in most cases. Turbulent blood flow in the RVOT might lead to endothelial damage predisposing to nonbacterial thrombotic endocarditis that can turn infective after any transient bacteremia 5.…”

Section: Discussionmentioning

confidence: 68%

“…In another study of explanted infected Melody valves,50 pathologic examination revealed the presence of granulocytes in the preexisting surgical conduit in all cases, denoting that the space between the Melody valve stent and the underlying conduit with little neovascularization might represent a blind spot that cannot be reached by antibiotics. This blind spot seems to harbor the microorganism leading to failure of antibiotics to eradicate the infection.…”

Section: Discussionmentioning

confidence: 95%

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Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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BackgroundInfective endocarditis (IE) after transcatheter pulmonary valve implantation (TPVI) in dysfunctioning right ventricular outflow tract conduits has evoked growing concerns. We aimed to investigate the incidence and the natural history of IE after TPVI with the Melody valve through a systematic review of published data.Methods and ResultsPubMed, EMBASE, and Web of Science databases were systematically searched for articles published until March 2017, reporting on IE after TPVI with the Melody valve. Nine studies (including 851 patients and 2060 patient‐years of follow‐up) were included in the analysis of the incidence of IE. The cumulative incidence of IE ranged from 3.2% to 25.0%, whereas the annualized incidence rate ranged from 1.3% to 9.1% per patient‐year. The median (interquartile range) time from TPVI to the onset of IE was 18.0 (9.0–30.4) months (range, 1.0–72.0 months). The most common findings were positive blood culture (93%), fever (89%), and new, significant, and/or progressive right ventricular outflow tract obstruction (79%); vegetations were detectable on echocardiography in only 34% of cases. Of 69 patients with IE after TPVI, 6 (8.7%) died and 35 (52%) underwent surgical and/or transcatheter reintervention. Death or reintervention was more common in patients with new/significant right ventricular outflow tract obstruction (69% versus 33%; P=0.042) and in patients with non‐streptococcal IE (73% versus 30%; P=0.001).ConclusionsThe incidence of IE after implantation of a Melody valve is significant, at least over the first 3 years after TPVI, and varies considerably between the studies. Although surgical/percutaneous reintervention is a common consequence, some patients can be managed medically, especially those with streptococcal infection and no right ventricular outflow tract obstruction.

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“…Histopathologic studies have confirmed the same finding,50 as have other reports,14, 19 concluding that insufficiency is a rare manifestation of Melody valve IE.…”

Section: Discussionsupporting

confidence: 82%

Section: Discussionmentioning

confidence: 68%

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Abdelghani

Nassif

Blom

et al. 2018

JAHA

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“…Schneider et al [21] performed an ex-vivo assessment of nine percutaneously implanted valved Melody ® conduits after surgical explantation, by means of histology and immunohistochemistry. The authors found that in the absence of infection, the valve cusps were clinically competent and histologically thin and intact.…”

Section: Histological Lesions Are Induced From the Early Steps Of Valmentioning

confidence: 99%

“…To date, there are no published data reporting early calcification or degeneration of the Melody ® valve in the pulmonary position. Although early failure of Melody ® valves implanted within bioprosthetic tricuspid valves has been reported, the pathophysiology of these isolated cases remains unclear [21,23]. Furthermore, the mid-term valvular function of the Melody ® valve is encouraging, although long-term data are lacking [3,4].…”

Section: Histological Lesions Are Induced From the Early Steps Of Valmentioning

confidence: 99%

Impact of percutaneous pulmonary valve implantation procedural steps on leaflets histology and mechanical behaviour: An in vitro study

Jalal

Galmiche

Beloin

et al. 2016

Archives of Cardiovascular Diseases

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Transcatheter pulmonary valve replacement: State of the art

Holzer

Hijazi

2015

Cathet Cardio Intervent

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Melody transcatheter valve: Histopathology and clinical implications of nine explanted devices

Cited by 21 publications

References 23 publications

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Infective Endocarditis After Melody Valve Implantation in the Pulmonary Position: A Systematic Review

Impact of percutaneous pulmonary valve implantation procedural steps on leaflets histology and mechanical behaviour: An in vitro study

Transcatheter pulmonary valve replacement: State of the art

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