Pediatric Transcatheter Valve Replacement

Transformative advances in medical technology rarely occur in isolation, but rather may be indirectly informed, if not accelerated, by advances in related fields. Bonhoeffer et al1 introduced the first transcatheter valve in 2000, implanting it in a 12-year-old boy with tetralogy of Fallot. The report of the transcatheter aortic valve by Cribier a mere 2 years later suggests the interdependence of investigators on breakthroughs in related fields.2 The advancements in cardiac devices are shared among pediatric and adult cardiologists, with benefits ideally befalling both patient populations when a breakthrough occurs, whether that technology was initially introduced for adults or children.Article see p 1960 is notable that the Melody valve implanted in 2015 is in large part the same device and delivery system as the first transcatheter valve implanted in 2000. The operator learning curve has been significant, whereas the device has remained for the most part unmodified. The unchanging character of the valve speaks to 2 issues specifically.When considering the performance and clinical utility of a bioprosthetic valve, one might subscribe to the British surgeon Dr Donald Ross’s approach: the primary consideration is the early safety and efficacy of the valve, with secondary value placed on valve durability.3 In consideration of early safety and efficacy, the Melody valve has shown excellent results. As has been demonstrated in multiple studies, a significant learning curve occurred to optimize patient safety during transcatheter valve implantation – such as careful coronary artery assessment, prestenting the outflow tract, and anticipation of outflow tract tearing.4,5 It is worth remembering that some of the experiences on this technical learning curve are embedded within the results of the current midterm study by Cheatham et al6 in this issue of Circulation .Early efficacy has also been previously demonstrated …