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

Serfas, John D.; Turek, Joseph W.; Haney, John C.; Krasuski, Richard A.; Fleming, Gregory A.

doi:10.1002/ccd.28591

Cited by 7 publications

(8 citation statements)

References 9 publications

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“…These approaches included full sternotomy for MPA banding with or without RV access, subxyphoid incision with RV access, and more recently, lateral thoracotomy for MPA plication. 10 , 11 , 13 , 14 , 15 , 17 , 18 , 19 , 20 The method studied in this article avoids cardiopulmonary bypass and sternotomy. By avoiding cardiopulmonary bypass, the potential sequences from systemic inflammatory process, including end‐organs injury, can be eliminated.…”

Section: Discussionmentioning

confidence: 99%

“…Although surgical plication has been our approach, complete MPA banding has been achieved by Serfas et al in their 2‐case series through left lateral thoracotomy. 14 We believe that the fluoroscopic balloon sizing evaluation we perform has helped us overcome this issue. A complete encirclement of the MPA with a band was only used at our institution when full sternotomies were performed, and these cases are not included in this study cohort.…”

Section: Discussionmentioning

confidence: 99%

“… 7 Many hybrid methods have also been developed to allow for the use of commercially available transcatheter devices in complex anatomies by either surgical alternation of the existing anatomy (typically off‐pump surgical plication or main pulmonary artery [MPA] banding) or surgically providing direct access to the heart through the right ventricle. 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 , 16 We are presenting in this article our institution's experience using the hybrid approach for PVR in patients with a large RVOT. The method we adapted included a left anterior thoracotomy with pulmonary artery banding followed by transcatheter PVR using a Sapien S3 valve.…”

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confidence: 99%

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Single‐Center Experience of Hybrid Pulmonary Valve Replacement Using Left Anterior Thoracotomy With Pulmonary Artery Plication in Patients With Large Right Ventricular Outflow Tract

Carr

Nijres

Windsor

et al. 2022

JAHA

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Background Until recently, a large right ventricle outflow tract interfered with the feasibility of standard transcatheter pulmonary valve replacement (PVR). We are describing our experience using a hybrid approach for PVR using a left anterior thoracotomy approach to allow for plication of the main pulmonary artery followed by a transcatheter PVR using a Sapien S3 valve. Methods and Results This is a single‐center, retrospective review of patients who were evaluated to be appropriate for a hybrid PVR approach. The patients' demographics, procedure details, and follow‐up data were collected. Between May 2018 and April 2021, a total of 11 patients presented for hybrid transcatheter PVR. The median age and weight were 24 years (interquartile range, 19–43 years) and 81.8 kg (interquartile range, 69–91 kg), respectively. Nine out of 11 patients received a transcatheter PVR after main pulmonary artery plication. There were no procedurally related deaths. One major complication was encountered in which the valve was malpositioned requiring successful surgical PVR. Minor complications included acute kidney injury (n=1) and a broken rib (n=1). The median length of stay was 4 days (interquartile range, 2–4 days), with median follow‐up of 7 months (interquartile range, 3–18 months). A well‐functioning pulmonary valve was observed in all patients at the last follow‐up. Conclusions A hybrid approach using left anterior thoracotomy with pulmonary artery plication followed by transcatheter Sapien S3 PVR provides a less‐invasive option for patients with an enlarged right ventricular outflow tract. Preliminary results demonstrated this to be a safe option with good short‐term outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Single‐Center Experience of Hybrid Pulmonary Valve Replacement Using Left Anterior Thoracotomy With Pulmonary Artery Plication in Patients With Large Right Ventricular Outflow Tract

Carr

Nijres

Windsor

et al. 2022

JAHA

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“…It is not uncommon for patients with free PR to have a severely dilated main pulmonary artery and annulus, which increases the challenges or decreases their candidacy for the pure transcatheter approach. A hybrid approach with pulmonary artery banding via a LAMI and transcatheter placement of the prosthesis has been described for those who are not candidates for a transcatheter approach 9 …”

Section: Discussionmentioning

confidence: 99%

Pulmonary valve replacement via left anterior minithoracotomy: Lessons learned and early experience

et al. 2021

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Objective Median sternotomy has been the standard for pulmonary valve replacement (PVR) in patients with free pulmonary regurgitation (PR) and right ventricular enlargement. With the introduction of transcatheter therapy, the search for an alternate to sternotomy is mandated. We present our early experience with a limited anterior left thoracotomy approach. Methods We used a left anterior mini‐thoracotomy in six male patients (15 ± 1.94 years of age) who developed progressive right ventricular enlargement due to chronic PR. Results Primary diagnoses were tetralogy of Fallot in five patients and pulmonary atresia with an intact septum in another. Four patients had previous median sternotomy with transannular patch repair. The mean right ventricular end‐diastolic volume index was 189 ± 27.13 ml/m2. The procedure was feasible in all patients. All patients had satisfactory adult size pulmonary bioprosthesis (25 or 27 mm valve), with a mean peak gradient of 18 ± 2.40 mmHg across the prosthesis at discharge. All patients were extubated intraoperatively at the end of the procedure and required no intraoperative transfusions. There were no early or late mortalities. Early morbidities included left hemidiaphragm paralysis in one patient, and re‐sternotomy for prosthetic valve endocarditis in one. One patient required late reoperation for a common femoral artery pseudoaneurysm. Conclusions Minimally invasive access for PVR is feasible in both primary and repeat settings, through a limited anterior left minithoracotomy in the absence of intracardiac shunts and the need for other concomitant cardiac procedures. Longer‐term studies with a larger number of patients are needed to compare the efficacy of this approach to standard sternotomy.

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“…The subxyphoid incision needed for perventricular valve deployment is cranially extended to achieve an adequate plication of the RVOT and MPA. This plication could also be performed via a left anterior thoracotomy as reported by Serfas and coworkers, 12 completing the procedure with a standard percutaneous approach for PVR instead of using a perventricular approach.…”

Section: Commentmentioning

confidence: 99%

A Hybrid Strategy for Geometrical Reshaping of the Main Pulmonary Artery and Transcatheter Pulmonary Valve Replacement

Lugones

Barbosa

Schvartz

et al. 2021

World J Pediatr Congenit Heart Surg

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Transcatheter pulmonary valve replacement has become an attractive alternative to surgical approach in patients with dysfunctional right ventricular outflow tract. However, in certain cases, an unfavorable anatomy might complicate optimal valve deployment and stability. Several techniques have been described to reshape the landing zone and allow proper implantation of the transcatheter valve. Among them, the hybrid approach has gained attention as an interesting method for off-pump pulmonary valve replacement in patients with dilated right ventricular outflow tract. But to date, there is no standardized method to resize and reshape the landing zone for the stented valve. Here, we describe a reproducible method based on simple geometric rules to allow adequate remodeling of the main pulmonary artery to the desired dimensions in a single attempt, followed by perventricular implantation of a Venus P-valve.

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

Cited by 7 publications

References 9 publications

Single‐Center Experience of Hybrid Pulmonary Valve Replacement Using Left Anterior Thoracotomy With Pulmonary Artery Plication in Patients With Large Right Ventricular Outflow Tract

Single‐Center Experience of Hybrid Pulmonary Valve Replacement Using Left Anterior Thoracotomy With Pulmonary Artery Plication in Patients With Large Right Ventricular Outflow Tract

Pulmonary valve replacement via left anterior minithoracotomy: Lessons learned and early experience

A Hybrid Strategy for Geometrical Reshaping of the Main Pulmonary Artery and Transcatheter Pulmonary Valve Replacement

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