Qiang Chen1, Mark Turner2, Massimo Caputo3, Serban Stoica3, Stefano Marianeschi4, Andrew Parry3. 1. Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom. Electronic address: qiangchen79@hotmail.com. 2. Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom. 3. Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom. 4. Paediatric Heart Institute, Hospital 12 de Octubre, Madrid, Spain.
Abstract
OBJECTIVE: The study objective was to review our initial experience with newly developed off-pump pulmonary valve implantation techniques and compare outcomes with the conventional approach. METHODS: Thirteen symptomatic patients with severe pulmonary regurgitation underwent pulmonary valve implantation, 6 without cardiopulmonary bypass (group 1: age, 28 ± 21 years; range, 12-62; body surface area range, 1.38-2.39 m(2)) and 7 with cardiopulmonary bypass (group 2: age, 23 ± 13 years; range, 10-46; body surface area range, 1.31-1.89 m(2)). Ten patients had previous repair of tetralogy of Fallot, and 3 patients had pulmonary valvotomy/valvuloplasty. RESULTS: Mean operation times were 166 minutes (range, 110-240) in group 1 and 299 minutes (range, 221-375) in group 2 (P < .001). Hemoglobin level after chest closure was 13.4 and 9.8 g/dL in groups 1 and 2, respectively (P < .001). Postoperative chest drainage (median) was 78 and 300 mL in groups 1 and 2, respectively (P = .003). Blood product requirement was zero and 3 units (median) in groups 1 and 2, respectively (P < .014). There was no significant difference in postoperative ventilation time or lengths of intensive care unit and hospital stays between the 2 groups. Mean follow-up was 15 months; all patients are in New York Heart Association I/II. Echocardiography showed that peak velocity across the pulmonary valve was 2.2 and 2.0 in groups 1 and 2, respectively (P = .46). No patient had a paravalvular leak or more than mild pulmonary regurgitation. CONCLUSIONS: Off-pump pulmonary valve implantation is a good alternative for pulmonary valve replacement. The procedure reduces operating time, blood loss, and blood product requirement.
OBJECTIVE: The study objective was to review our initial experience with newly developed off-pump pulmonary valve implantation techniques and compare outcomes with the conventional approach. METHODS: Thirteen symptomatic patients with severe pulmonary regurgitation underwent pulmonary valve implantation, 6 without cardiopulmonary bypass (group 1: age, 28 ± 21 years; range, 12-62; body surface area range, 1.38-2.39 m(2)) and 7 with cardiopulmonary bypass (group 2: age, 23 ± 13 years; range, 10-46; body surface area range, 1.31-1.89 m(2)). Ten patients had previous repair of tetralogy of Fallot, and 3 patients had pulmonary valvotomy/valvuloplasty. RESULTS: Mean operation times were 166 minutes (range, 110-240) in group 1 and 299 minutes (range, 221-375) in group 2 (P < .001). Hemoglobin level after chest closure was 13.4 and 9.8 g/dL in groups 1 and 2, respectively (P < .001). Postoperative chest drainage (median) was 78 and 300 mL in groups 1 and 2, respectively (P = .003). Blood product requirement was zero and 3 units (median) in groups 1 and 2, respectively (P < .014). There was no significant difference in postoperative ventilation time or lengths of intensive care unit and hospital stays between the 2 groups. Mean follow-up was 15 months; all patients are in New York Heart Association I/II. Echocardiography showed that peak velocity across the pulmonary valve was 2.2 and 2.0 in groups 1 and 2, respectively (P = .46). No patient had a paravalvular leak or more than mild pulmonary regurgitation. CONCLUSIONS: Off-pump pulmonary valve implantation is a good alternative for pulmonary valve replacement. The procedure reduces operating time, blood loss, and blood product requirement.
Authors: Rachael Heys; Gianni Angelini; Massimo Caputo; Lucy Culliford; Maria Pufulete; Barnaby C Reeves; Chris A Rogers; Serban Stoica; Andrew Parry Journal: BMJ Open Date: 2019-04-02 Impact factor: 2.692