Melody Valve Procedure a Safer, Less-invasive Option to Open-heart Surgery

Posted on Feb 10, 2017

Johns Hopkins All Children's Heart Institute is recognized as a Top 50 Children’s Cardiology & Heart Surgery Program by U.S. News & World Report 2016-2017

For a child like 6-year-old Audrina, who has successfully survived two open-heart surgeries and multiple cardiac procedures to repair a congenital heart defect, six years can seem like a lifetime.

It actually is a lifetime in medical technology.

Technology, procedures, medical equipment and devices are improving daily for patients such as Audrina who receives patient-centered cardiac care from one of the largest heart programs in the state of Florida: Johns Hopkins All Children’s Heart Institute.

In fact, when Audrina recently needed heart surgery to replace her pulmonary valve, which will require replacement every few years as she grows, she found that Johns Hopkins All Children’s Hospital now is offering a simpler, safer and less invasive surgery: the Melody valve.

“The Melody valve allows replacement of a pulmonary valve through a vein in the groin—the femoral vein—or neck—the jugular—as opposed to another open-heart surgery,” explains Gary Stapleton, M.D., Audrina’s cardiologist.

Stapleton is the division chief of pediatric cardiology and medical director of the cardiac catheterization lab at Johns Hopkins All Children’s. He works closely on complex interventions such as the one performed on Audrina with pediatric interventional cardiologist Carrie Herbert, M.D., who has participated in roughly 20 of these procedures during her training. Herbert joined Johns Hopkins All Children’s in 2015 after completing her training in pediatric and interventional cardiology.  “Having Dr. Herbert join us out of training only enhanced our knowledge and expertise in newer and safer procedures,” Stapleton explains. 

About the Melody Valve Procedure

The surgery usually takes one to two hours with the patient under anesthesia:
  1. A catheter holding the valve is inserted, usually into a vein in the patient’s leg, and guided to the heart.
  2. When the Melody valve is in the right position, balloons are inflated to expand it into place so blood flows between the patient’s right ventricle and lungs.
  3. The catheter is removed.
  4. An X-ray technique known as fluoroscopy confirms that the valve functions properly.
  5. The access site is closed. 

The procedure is much less invasive and usually only requires 23 hours of in-hospital observation as opposed to surgery, which typically requires a one-week stay in the CVICU. The patients can also return to their normal activities within a week of the procedure as opposed to surgery, which requires significant activity restrictions for up to eight weeks. “Audrina has already had two open-heart surgeries, so by doing this procedure we were able to avoid a third open-heart surgery in the first six years of her life. With each open-heart surgery, there is increased risk of bleeding or damage to the heart due to significant scar tissue that builds up in the chest,” Stapleton explains.

Audrina’s parents were understandably thrilled to see that risk reduced.

“Because Dr. Stapleton and the heart institute added this innovative technology, it meant we didn’t have to go out of state or wherever to have this procedure done,” Audrina’s mom, Rachel, explains. “She is so active. She is living a normal life with ballet, gymnastics, tumbling ... and it’s all because of the doctors here at Johns Hopkins All Children’s.”

“Audrina’s Melody valve is functioning beautifully with no residual stenosis or valve leak,” Stapleton reports. “The size of her right ventricle is now nearly normal.  She has returned to all of her normal activities and her mother reports she is very lively.”

Unfortunately, the surgical or transcatheter valve options don’t last forever, so Audrina is likely to need additional procedures down the road. “We are hopeful that the Melody valve will last for several years.  At that point there may be the ability to implant a second valve inside of this one when the need arises, although I suspect she will need another open-heart surgery to put in a larger diameter conduit when she is a teenager or young adult to accommodate for her growth,” Stapleton explains.

“We are constantly striving to find ways to perform procedures that are less invasive, safer, and require less time for recovery in our patients,” Herbert adds. “Adding new procedures like the Melody valve enhances our ability to do this, and keeps us on the forefront of being able to offer innovative procedures for our patients. There is a second transcatheter valve that was recently FDA approved for pediatric use, and there are many more in development or trials that will likely expand the number of available options as well as the number and type of patients who are eligible to have these procedures.”

Meanwhile, Audrina’s parents take comfort that she is receiving innovative, expert care every step of the way. They have gone out of their way to raise funds for what Audrina and her mom call their “favorite hospital.” Audrina and her mom appeared on the 2016 US 103.5 FM Cares For Kids Radiothon in December to share their story of benefitting from advancements in technology and research.

“I don’t think people realize how lucky we are to have such a wonderful hospital right here from minor things to major,” Rachel told listeners. Audrina had something to add:

“Now I can swim in the pool and play mermaid with my dad,” she said shyly.

From the swash of a mermaid’s tail to a graceful pirouette, Audrina is making every moment of this lifetime count with her new Melody valve.

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