Percutaneous heart valve implantation: a non-invasive alternative to open-heart surgery

Percutaneous heart valve implantation is an innovative, minimally invasive alternative to open-heart surgery for treating valvular heart disease. Over the last 10 years, research at UCL has advanced the original method of minimally invasive valve implantation in the pulmonary position. Over 7,000 patients have now benefited from this procedure.

Around eight in every 1,000 children are born with congenital heart disease, and around 20% of these suffer from dysfunction of the right ventricular outflow tract (RVOT). Surgery to treat the condition is very effective, but the valve conduits that are inserted to connect the right ventricle to the pulmonary artery have a limited lifespan - often less than 10 years - and as a result patients require multiple open-heart operations.

Research at UCL, in collaboration with clinicians at Great Ormond Street Hospital for Children, has developed a new, less invasive percutaneous method to insert a heart valve without the need for open-heart surgery. This avoids potential complications, long hospital stays, a long time off work or school, and has the potential to significantly alter the lifelong treatment of these patients.

The first percutaneous pulmonary valve was performed in 2000 in a pilot case (one child) in Paris, France. In 2002, the lead doctor, Professor Philippe Bonhoeffer, moved to UCL to assess whether implantation of the device could reduce the need for open-heart surgery in a broader patient group. A programme of research over the next four years established the feasibility and safety of the procedure, and developed ways of monitoring patients to avoid adverse consequences.

The valve was commercialised by Medtronic as the Melody™ device. It was licensed in Europe and Canada in 2006 and in the US in 2010. By 2013, over 5,000 valves had been implanted in 35 countries worldwide. In 2012, the Melody device was awarded the Prix Galien USA 2012 award for Best Medical Technology.

UCL researchers are now working with Medtronic on a new device which is suitable for many more patients with pulmonary valve disease, where the main pulmonary artery is too dilated for the procedure. The device is now in early phase clinical testing, with three patients implanted so far.

Related links

• NICE guidance - IPG436 Percutaneous pulmonary valve implantation for right ventricular outflow tract dysfunction
• FDA Medtronic Melody approval
• Medtronic Melody System

Image

• Melody® Transcatheter Pulmonary Valve (courtesy of Medtronic)