Hybrid pulmonary artery plication followed by transcatheter pulmonary valve replacement: Comparison with surgical PVR

Abstract

Objective/Background Historically, the sole option for patients with a dysfunctional native right ventricular outflow tract (RVOT) requiring re-establishment of pulmonary competence has been surgical PVR. We sought to compare early outcomes of hybrid pulmonary valve replacement (PVR) combining surgical plication of the main pulmonary artery followed by transcatheter PVR, with a contemporary cohort of surgical PVR patients. Methods Retrospective chart analysis of all patients with a dilated native RVOT eligible for surgical PVR over 36 months was performed. The cohorts included patients with previous tetralogy of Fallot repair (n = 14), and previous intervention for congenital abnormality of the pulmonary valve (n = 7). Results Twenty-one patients with a dysfunctional native RVOT met criteria for PVR; 8 using the hybrid procedure (group 1: age, 31.5 +/- 17.4 years) and 13 with cardiopulmonary bypass (CPB) (group 2: age, 31 +/- 18.4 years). Valve delivery was successful in all patients with no procedural mortality. Group 1 had a lesser requirement for blood products (P =< 0.001) and a trend toward shorter hospital stay and higher post-operative hemoglobin. No patients in group 1 received inotropic support post-operatively compared to 54% of patients in group 2. Mean follow-up was 3.4 months for group 1 and 13.6 months for group 2 with the average peak gradient across the RVOT of 20.1 and 15.1 mm Hg respectively (P = 0.12), all with no more than mild PI. Conclusions Transcatheter hybrid PVR following RVOT plication provides a reasonable alternative to surgical PVR particularly in higher risk cohorts, reducing possible longer-term consequences of repeated runs of CPB. © 2016 Wiley Periodicals, Inc.

Hybrid transcatheter pulmonary valve replacement with a SAPIEN S3 valve after pulmonary artery banding via left lateral thoracotomy

“…Prior reports have involved a variety of surgical approaches (median sternotomy, lateral thoracotomy) and techniques (PA banding, RVOT plication), points of access (per‐ventricular, percutaneous), and valve types (Melody, Sapien XT). The largest series of hybrid TPVR compared eight patients with hybrid TPVR using a Melody valve following RVOT modification through a median sternotomy to 13 matched patients who underwent surgical PVR and showed the hybrid approach to be associated with fewer blood transfusions and a trend toward shorter length of stay. Median sternotomy is the most commonly reported approach in the literature, with reports of a thoracotomy increasing in frequency in more recent publications …”

Transcatheter valve replacement in congenital heart disease: the present and the future

“…The treatment of large diameter (>30 mm) native RVOTs require either narrowing of the RVOT17 or new larger valve platforms. The Venus P valve (Venus Medtech, China) and the Harmony valve (Medtronic, Minneapolis,  Minnesota, USA) are self-expanding covered hourglass-shaped RVOT reducer platforms with the valve in the central waist.…”

Percutaneous pulmonary valve implantation – state of the art and Polish experience

“…Recently, Edwards described an Altera Device, one size (40 × 45 mm) nitinol self-expanding covered stent providing a rigid landing zone for SAPIEN S3 29 mm, suitable for RVOT diameters up to 38 mm [52]. In some cases hybrid procedures with mutual collaboration from cardiac surgery and interventional cardiology are proposed [53].…”