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Comparing the Use of the Melody Valve and Mechanical Valves for Pediatric Mitral Valve Replacement
Anna Olds, Brigitte Kazzi, Matthew Liava'a, Matthew A. Crystal, Alejandro Torres, Damien LaPar, Paul Chai, Emile Bacha, David Kalfa.
Columbia University Medical Center, New York, NY, USA.

OBJECTIVE: Options for pediatric mitral valve replacement (MVR) have shown poor outcomes. The Melody valve may be more durable and can be dilated with somatic growth. Placement of the Melody valve stent in the left atrium (“high-riding” implantation) may improve its longevity and decrease left ventricular outflow obstruction. We compare outcomes after high-riding Melody and mechanical MVR in children.METHODS: We retrospectively reviewed pediatric MVRs at our institution from 2013-2018, including 10 high-riding Melody MVRs (8 patients), and 17 mechanical MVRs. All Melody valves were placed in a supraannular high-riding position. Mortality and valve failure were primary outcomes. Valve failure was defined as regurgitation/stenosis≥moderate, valve thrombosis, or endocarditis.
RESULTS: Patient characteristics and outcomes are presented in Table 1. Melody and mechanical groups had similar preoperative mitral gradients, stenosis/regurgitation, ejection fractions and follow-up. Patients were similar ages. Melody patients had significantly smaller valves implanted (p=0.009). Two mechanical patients died in-hospital, while no Melody patient died (p=0.55). Valve failure occurred in six mechanical (one valve thrombosis, five valve stenosis≥moderate) and three Melody patients (two structural degenerations, one endocarditis) (p=1.00). There was no LVOTO and one case of pulmonary vein obstruction in the Melody group. Valve reoperation was needed in one mechanical patient (thrombectomy) and four Melody patients (all repeat MVR) (p=0.047). There was no stroke in either group and no percutaneous dilations in the Melody group at last follow-up.
CONCLUSIONS: Supraannular Melody MVR can be performed successfully and safely in young patients with similar rates of valve failure. Melody MVR seems to compare favorably to mechanical in terms of survival, but at the expense of possibly more reoperations. Studies with larger follow-up and sample sizes are warranted.

Table 1
Mechanical (n=17)Melody (n=10)P-value
Follow-up (years)2.89±0.861.91±1.780.07
Age (years)5.62±6.102.22±1.420.098
Valve size ≤20mm, n (%)8 (47%)10 (100%)0.009
Mortality2 (12%)00.55
Valve failure6 (35%)3 (33%)1.00
Mitral stenosis ≥moderate5 (29%)00.12
Structural degeneration/endocarditis03 (33%)0.04
Mitral valve thrombosis1 (6%)01.00
Mitral valve reoperation1 (6%)4 (40%)0.047

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