Recent Development in Pulmonary Valve Replacement after Tetralogy of Fallot Repair: The Emergence of Hybrid Approaches

Abstract

An increasing number of patients with tetralogy of Fallot require repeat surgical intervention for pulmonary valve replacement secondary to pulmonary regurgitation. Catheter-based interventions have emerged as an attractive alternative to surgery in this patient population but it is limited by patient size or the anatomy of the right ventricular outflow tract. Hybrid approaches involving both cardiac interventionists and surgeons are being developed to overcome these limitations. The purpose of this review is to highlight the recent advances in the hybrid field of pulmonary valve replacement, summarizing the advantages and disadvantages of the “traditional” surgical and the new catheter-based techniques and discuss the direction future research should take to determine the optimal management for individual patients.

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

“…Various approaches to hybrid pulmonic valve replacement have been described, typically in patients not considered candidates for surgical PVR. 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.…”

Anchor balloon, buddy wire, and wire and sheath techniques to deploy percutaneous pulmonary valves in tetralogy of fallot patients

“…An increasing number of adult congenital heart disease patients with tetralogy of Fallot (TOF) are surviving into adulthood. The mortality in TOF patients has declined from 50% in the 1950s to less than 2% , with 90% of them living beyond 40 years of age . Pulmonary valve regurgitation is a common late consequence of surgical repair of TOF.…”

“…Pulmonary valve regurgitation is a common late consequence of surgical repair of TOF. As patients live longer, the severity of pulmonary valve regurgitation worsens leading to progressively worsening of right ventricular (RV) function, decrease in exercise tolerance, worsening heart failure, and arrhythmias .…”

“…PVR improves RV function and symptoms . Traditionally, the pulmonary valve was replaced surgically; however, there have been advancements in the percutaneous approach to PVR and in selective cases percutaneous pulmonary valve implantation may be an optimal option.…”

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

“…Chronic severe pulmonary valve regurgitation (PR) following treatment of congenital heart defects in infancy leads to right ventricular and atrial enlargement which predisposes patients to right heart failure, arrhythmias, and sudden cardiac death . Subsequently nearly all of these patients require pulmonary valve replacement (PVR) later in life.…”