Risk of infective endocarditis after hybrid Melody mitral valve replacement in infants: The French experience

Introduction

Surgical management of mitral valve (MV) disease is challenging in infants. We aimed at reporting the French experience with Melody mitral valve replacement (MVR).

Methods

A retrospective cohort study reporting the French experience with Melody MV replacement (MVR).

Results

Seven symptomatic infants (complete atrioventricular septal defect [n = 4, down syndrome: n = 3], hammock MV [n = 3]) underwent Melody MVR (age: 3 months [28 days–8 months], weight: 4.3 kg [3.2–6.4 kg]) because of severe MV regurgitation (6) or mixed MV disease (1) and 14 mm (11–16 mm) MV annulus. In 2 patients whose MV was felt irreparable, Melody MVR was performed straightaway. The others underwent 2 (1–3) previous attempts of MV repair; 3 were on ECMO. Melody MVR led to competent valve and low gradient (3 mmHg, [1–4 mmHg]). One patient died 3 days post-implant from ECMO-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, one underwent balloon expansions of the valve at 9- and 16-months post-implant, and mechanical MVR at 2 years; another is currently planned for transcatheter Melody valve dilation.

Conclusion

Melody MVR may be considered in selected infants with small MV annulus as an alternative to mechanical MVR. Our experience highlights a high-risk of late IE that deserves further consideration.