Left Anterior Mini-Incision for Pulmonary Valve Replacement in a 12-Year-Old

Vekstein, Andrew M.; Nellis, Joseph R.; Meza, James M.; Andersen, Nicholas D.; Haney, John C.; Turek, Joseph W.

doi:10.1177/1556984520911026

Cited by 3 publications

(4 citation statements)

References 10 publications

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“…The youngest patient in our series was 13 years old with previous repair of TOF. Vekstein et al 13 reported LAMI in a 12‐year‐old male with TOF. We agree with others that patients who are candidates for this procedure should be at least 30 kg in weight to allow safe groin vessel cannulation 12 .…”

Section: Discussionmentioning

confidence: 97%

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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Section: Discussionmentioning

confidence: 97%

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

et al. 2021

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“…As previously described, this approach involves peripheral femoral-femoral cardiopulmonary bypass via a 6 mm end-to-side Dacron graft on the artery, direct venous cannulation and exposure of the right ventricular outflow tract through a 5 cm incision in the left third interspace (Fig 1a-d). 10,11 Transesophageal echocardiogram (TEE) confirms the absence of an atrial septal defect and the final repair is completed on a beating heart. 9,11 To augment drainage for improved visualisation, a singlestage venous cannula in the left subclavian vein was added, only as needed.…”

Section: Methodsmentioning

confidence: 99%

“…10,11 Transesophageal echocardiogram (TEE) confirms the absence of an atrial septal defect and the final repair is completed on a beating heart. 9,11 To augment drainage for improved visualisation, a singlestage venous cannula in the left subclavian vein was added, only as needed.…”

Section: Methodsmentioning

confidence: 99%

Comparison of median sternotomy and left anterior mini-incision for pulmonary valve replacement following primary tetralogy of Fallot repair

et al. 2022

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Objective: Pulmonary insufficiency requiring reintervention frequently occurs after primary tetralogy of Fallot repair. Repeat interventions present a challenge for both the surgeon and patient. We compare a minimally invasive, 5 cm left anterior mini-incision to redo median sternotomy for pulmonary valve replacement in tetralogy of Fallot patients. Methods: Following Internal Review Board approval, we conducted a single institution retrospective review of patients with tetralogy of Fallot who underwent pulmonary valve replacement via redo median sternotomy or left anterior mini-incision between 13 July, 2016 and 6 March, 2020. Results: Twenty-three patients underwent pulmonary valve replacement following primary tetralogy of Fallot repair between March 2016 and March 2020. Twelve patients received a redo-median sternotomy from March 2016 to August 2018. Left anterior mini-incision was first offered in August of 2018 and was chosen by all eleven patients thereafter. The two groups had similar baseline characteristics including preoperative pulmonary valve dysfunction. Early trends suggest a longer cardiopulmonary bypass time for patients who received left anterior mini-incisions. Other outcomes were comparable, including operative times, blood product requirements, residual pulmonary valve dysfunction, postoperative pain, narcotic requirements, ICU length of stay, total length of stay, and postoperative complications. Conclusions: In patients who have previously undergone primary repairs of tetralogy of Fallot, outcomes for pulmonary valve replacement via left anterior mini-incision are comparable to those via redo median sternotomy.

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“…Since late 2018, our group has performed 19 operations, including 14 redo PVRs following primary tetralogy of Fallot repair, through a 5-cm left anterior mini-incision. 3,4 In our series, the median age for patients undergoing left anterior mini-incision was 16 years old (13-23 years) with a median body mass index of 20 (19-29). Two patients with body mass indexes of>30 and multiple previous median sternotomies were converted to sternotomy due to dense adhesions and inadequate exposure.…”

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confidence: 86%

Commentary: Minimally invasive pulmonary valve replacement and the adoption curve for novel techniques

2021

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Left Anterior Mini-Incision for Pulmonary Valve Replacement in a 12-Year-Old

Cited by 3 publications

References 10 publications

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

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

Comparison of median sternotomy and left anterior mini-incision for pulmonary valve replacement following primary tetralogy of Fallot repair

Commentary: Minimally invasive pulmonary valve replacement and the adoption curve for novel techniques

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