Percutaneous pulmonary valve implantation (PPVI) using Melody® valve has been validated as a valuable therapeutic option for the management of right ventricular outflow tract (RVOT) dysfunction but remains challenging [1Lurz P., Coats L., Khambadkone S., et al. Percutaneous pulmonary valve implantation: Impact of evolving technology and learning curve on clinical outcome Circulation 2008 ;  117 : 1964-1972 [cross-ref]

Cliquez ici pour aller à la section Références, 2Cheatham J.P., Hellenbrand W.E., Zahn E.M., et al. Clinical and Hemodynamic Outcomes up to 7 Years After Transcatheter Pulmonary Valve Replacement in the US Melody Valve Investigational Device Exemption Trial Circulation 2015 ;  131 : 1960-1970 [cross-ref]

Cliquez ici pour aller à la section Références, 3McElhinney D.B., Hellenbrand W.E., Zahn E.M., et al. Short- and medium-term outcomes after transcatheter pulmonary valve placement in the expanded multicenter US melody valve trial Circulation 2010 ;  122 : 507-516 [cross-ref]

Cliquez ici pour aller à la section Références]. The “Folded” modification of the Melody® valve has been reported as a safe and feasible technique in complex RVOT [4Jalal Z., Malekzadeh-milani S., Hofbeck M., et al. A new percutaneous pulmonary valve implantation technique for complex right ventricular outflow tracts: The “Folded Melody Valve” Cathet. Cardiovasc. Intervent 2015 ;  85 : 604-610 [cross-ref]

Cliquez ici pour aller à la section Références]. We sought to evaluate mid-term outcomes in a multicentre cohort who underwent PPVI using the “folded” Melody® valve technique.

Patients who underwent PPVI using a Foled Melody® between April 2012 and November 2018 in 6 European tertiary Centers were retrospectively included.

“Folded” Melody® valve technique was successfully performed in 28 patients (mean age=17.7±10 years old). Indications were: short RVOT and early bifurcation of pulmonary arteries in 12 (42.8%) (Fig. 1), bioprosthetic valves in 10 (35.7%), coronary arteries proximity in 4 (14.3%) and prevention of retrosternal compression in 2 (7.2%). No complication occurred during procedures. All patients had excellent hemodynamic results. Mean transvalvular peak velocity decreased from 3.8±0.86m/s before PPVI to 2.4±0.55m/s in the immediate post-PPVI period. Only 5 patients had trivial pulmonary regurgitation (PR) at discharge. After a median follow-up (FU) of 27±17.9 months, all patients were alive, and all, but 3 patients, were free from reintervention: 1 patient (3.5%) developed Melody® valve infective endocarditis 3 months after PPVI and underwent RVOT surgical replacement; Two underwent pulmonary artery stenting 2 and 4 years after of PPVI, but the lesions were not related to the Folded valve. At last FU mean transvalvular peak velocity was 2.6±0.66m/s and only 5 (17.8%) patients had mild or less PR. No stent fractures were observed.

The “folded valve technique” is a safe and feasible modification of the Melody® valve which provides favourable mid-term results without increased rate of valve related complications.