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Risk of infective endocarditis after hybrid melody mitral valve replacement in infants: the French experience

Interdiscip Cardiovasc Thorac Surg. 2024 Mar 29;38(4):ivae046. doi: 10.1093/icvts/ivae046.

Paul Padovani  1   2 Zakaria Jalal  3   4   5 Virginie Fouilloux  6 Nadir Benbrik  1   2 Céline Grunenwald  1   2 Jean-Benoit Thambo  3   4   5 Philippe Aldebert  6 Maha Tagorti  1   2 François Roubertie  3   4   5 Olivier Baron  1 Caroline Ovaert  6   7 Mohamedou Ly  1 Alban-Elouen Baruteau  1   2   8   9

PMID: 38490258 PMCID: PMC11181930 DOI: 10.1093/icvts/ivae046

Abstract

Objectives: Surgical management of mitral valve disease is challenging in infants <1 year old. We aimed at reviewing the French experience with Melody mitral valve replacement in critically ill infants.

Methods: A retrospective cohort study reporting the French experience with Melody mitral valve replacement.

Results: Seven symptomatic infants [complete atrioventricular septal defect (n = 4, Down syndrome: n = 3), hammock valve (n = 3)] underwent Melody mitral valve replacement [age: 3 months (28 days to 8 months), weight: 4.3 kg (3.2-6.4 kg)] because of severe mitral valve regurgitation (6) or mixed valve disease (1) and 14 mm (11-16 mm) mitral valve annulus. In 2 patients whose valve was felt irreparable, Melody mitral valve replacement was performed straightaway. The others underwent 2 (1-3) previous attempts of valve repair; 3 were on extracorporeal membrane oxygenation. Melody mitral valve replacement led to competent valve and low gradient [3 mmHg, (1-4 mmHg)]. One patient died 3 days post-implant from extracorporeal membrane oxygenation-related stroke. Of the 6 discharged home patients, 3 (50%) were readmitted for a definite diagnosis (1) or high suspicion (2) of infective endocarditis, of which 2 died. Over the follow-up, 1 underwent balloon expansions of the valve at 9- and 16-months post-implant, and mechanical mitral valve replacement at 2 years; another is currently planned for transcatheter Melody valve dilation.

Conclusions: Melody mitral valve replacement may be considered in selected infants with small mitral valve annulus as an alternative to mechanical mitral valve replacement. Our experience highlights a high-risk of late infective endocarditis that deserves further consideration.

Keywords: Atrioventricular valve; Hybrid intervention; Infant; Infective endocarditis; Melody valve; Outcomes.

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