Multicenter Experience Evaluating Transcatheter Pulmonary Valve Replacement in Bovine Jugular Vein (Contegra) Right Ventricle to Pulmonary Artery Conduits

Abstract

The majority of Melody valves implanted early in the experience were within cryopreserved homograft conduits. A relatively common alternative to homograft conduits for RVOT reconstruction is the Contegra pulmonary valve conduit, a glutaraldehyde-preserved bovine jugular vein conduit (Medtronic, Inc), which is available in a range of sizes (12-22 mm) for use Background-Follow-up of transcatheter pulmonary valve replacement (TPVR) with the Melody valve has demonstrated good short-term and long-term outcomes, but there are no published studies focused on valve performance in the Contegra bovine jugular vein conduit. Methods and Results-This is a retrospective, multicenter study of the short-and intermediate-term outcomes of Melody TPVR within the Contegra conduit in the right ventricle to pulmonary artery position. Data from 13 centers were included in the analysis. During the study period, 136 patients underwent 139 catheterizations for attempted Melody TPVR with a median follow-up of 3 years (1 day to 9.1 years). Of the 136 patients, 117 underwent successful Melody TPVR. Two patients underwent a second Melody TPVR. The majority of patients underwent placement of ≥1 stents before transcatheter pulmonary valve implantation. There was a significant reduction in peak conduit pressure gradient acutely after transcatheter pulmonary valve implantation (39 versus 10 mm Hg; P<0.001). At most recent follow-up, the maximum pulmonary valve gradient by echocardiogram remained significantly reduced relative to prevalve implant measurements (65.9 versus 27.3 mm Hg; P<0.001). The incidence of Melody transcatheter pulmonary valve stent fracture (3.4%) and infectious endocarditis (4.3%) were both low. Serious adverse events occurred in 3 patients. Conclusions-Melody TPVR in Contegra conduits is safe and effective and can be performed in a wide range of conduit sizes with preserved valve function and low incidence of stent fracture and endocarditis. (Circ Cardiovasc Interv.

Implantation of the Melody transcatheter pulmonary valve PB1016 in patients with dysfunctional right ventricular outflow tract conduits

“…TPVR success rates were similar to prior reports . Stable valve position was achieved in all 30 patients who underwent attempted TPVR.…”

Association between patient age at implant and outcomes after transcatheter pulmonary valve replacement in the multicenter Melody valve trials

“…Endocarditis is an important complication and a risk factor for reintervention after TPVR . While multiple studies have evaluated factors associated with endocarditis in this patient population, none have shown age to be a risk factor, except for studies derived from the three prospective Melody valve trials .…”

“…Endocarditis is an important complication and a risk factor for reintervention after TPVR. 1,21,30 While multiple studies have evaluated factors associated with endocarditis in this patient population, none have shown age to be a risk factor, 21,[31][32][33][34] except for studies derived from the three prospective Melody valve trials. 21,35 In this study, freedom from endocarditis and freedom from reintervention for endocarditis were shortest in children (79 and 90% at 5 years, respectively), with most of the separation from the other age groups occurring beyond 2 years post-TPVR, even in the cohort of protected conduits.…”

Interventional Cardiology for Congenital Heart Disease

“…Growing experience with the procedure has lead to reports describing mounting of the pre-stent onto the valve system reducing the steps required for successful valve implantation, 45) and extension to patients with smaller RV-PA conduits and bioprsothetic valves. 46) 47) Limitations due to valve size in patients with dilated native RVOTs have been met with larger-diameter balloon expandable systems, 48) with simplification of the technique in these patients obviating the need for pre-stenting ( Figure 3 ). Many dysfunctional RVOT's however remain too large for current balloon expandable systems and clinical experience with a number of self-expanding systems have been reported.…”