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

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 mo [28 days-8mo], weight: 4.3 kg [3.2-6.4 kg]) because of severe mitral valve regurgitation (6) or mixed valve disease (1) and 14 mm (11-16mm) 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, [1-4mmHg]). 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, one 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 IE that deserves further consideration.