Melody Valve Implantation in the Tricuspid Position After Pediatric Heart Transplantation-A Case Report.

Tricuspid regurgitation (TR) is common after a heart transplant and is associated with worse clinical outcomes. The incidence ranges from 34% immediately after transplant to 20% by 10 years. Most patients can be managed medically; however, severe TR and symptomatic right heart failure warrant tricuspid valve replacement. The use of Melody transcatheter pulmonary valve in the tricuspid position is previously described. We report a unique case of posttransplant severe TR treated with surgical bioprosthetic tricuspid valve replacement who subsequently underwent successful transcatheter Melody valve placement in tricuspid position for progressive bioprosthetic valve stenosis with 11 years of follow-up.

Transcatheter Pulmonary Valve Replacement in Middle and Late Adulthood.

Transcatheter pulmonary valve replacement (TPVR) is now frequently performed in adult congenital heart disease (ACHD) patients. As the life-expectancy of the ACHD population continues to improve, more patients will require pulmonary valve intervention. This study details the short-term and mid-term clinical outcomes of patients aged 40 years and older undergoing TPVR. We performed an institutional retrospective cohort study that included patients aged 40 and older undergoing TPVR (and clinical follow up) from January 1, 2012 to January 1, 2024. Descriptive analyses, Kaplan-Meier survival analysis, and Cox proportional hazard modeling were utilized to determine outcomes and risk factors affecting survival. The study included 67 patients and median age at TPVR was 48 [43,57] years. Median hospital length of stay following TPVR was 1 [1,3] day, peri-procedural complications occurred in 5 patients and acute kidney injury occurred in 1 patient. Median duration of follow-up was 3.5 [0.1,9.7] years. There were 9 total deaths and 1, 3, and 5-year Kaplan-Meier survival after TPVR was 95%, 91%, and 82%, respectively. Moderate or worse right ventricular dysfunction was present in 22 patients before TPVR and in 20 patients after TPVR. Inpatient status prior to TPVR negatively impacted survival (HR = 24.7 [3.3, 186.1], p=0.002). In conclusion, TPVR was performed in patients ages 40 and older with favorable periprocedural and mid-term follow-up outcomes including survival, but right ventricular dysfunction did not improve and further exploration on ideal timing of TPVR in this age group is warranted.