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. The “Folded” modification of the Melody®valve has been reported as a safe and feasible technique in complex RVOT. 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 Centerswere 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.