Sitaram M. Emani, MD, Breanna L

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Presentation transcript:

Concept of an expandable cardiac valve for surgical implantation in infants and children Sitaram M. Emani, MD, Breanna L. Piekarski, RN, BSN, David Zurakowski, PhD, Christopher A. Baird, MD, Audrey C. Marshall, MD, James E. Lock, MD, Pedro J. del Nido, MD The Journal of Thoracic and Cardiovascular Surgery Volume 152, Issue 6, Pages 1514-1523 (December 2016) DOI: 10.1016/j.jtcvs.2016.08.040 Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 1 Kaplan-Meier curves depicting freedom from mortality or cardiac transplantation (A), structural valve deterioration (SVD) (B), and cardiac reoperation (C). SVD is categorized as central regurgitation and noncentral deterioration. CI, Confidence interval. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1514-1523DOI: (10.1016/j.jtcvs.2016.08.040) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 2 Gross examination of explanted valve from a patient at 3 months after implantation with suture injury to leaflet (A), and patient undergoing planned cardiac transplantation (B) demonstrating thin and mobile leaflets. Shown is a low-power (4×) view of an hematoxylin and eosin–stained section through an explanted Melody valve leaflet and attached section of jugular vein wall at 12 months after implantation. C, The leaflet is thin, as seen in the 20× magnification (inset). No inflammation or calcification of the leaflet is evident, whereas areas of calcification and inflammation are present in the vein wall. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1514-1523DOI: (10.1016/j.jtcvs.2016.08.040) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Figure 3 Transvalvular gradient (A) and regurgitation grade (B) immediately before and after balloon dilation of the valve. A significant reduction in transvalvular gradient is seen (P < .001). The grade of regurgitation was not significantly different before and immediately after balloon dilation. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1514-1523DOI: (10.1016/j.jtcvs.2016.08.040) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Modified Melody valve with pericardial skirt and shortened stent. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1514-1523DOI: (10.1016/j.jtcvs.2016.08.040) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

Video 1 Insertion of the Melody valve into the mitral position with a subsequent saline test and balloon dilation. Video available at http://www.jtcvsonline.org/article/S0022-5223(16)31072-8/addons. The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1514-1523DOI: (10.1016/j.jtcvs.2016.08.040) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions

The Journal of Thoracic and Cardiovascular Surgery 2016 152, 1514-1523DOI: (10.1016/j.jtcvs.2016.08.040) Copyright © 2016 The American Association for Thoracic Surgery Terms and Conditions