Open Access

ARTICLE

A Systematic Approach to Pulmonary Valve Replacement in the Current Era

by R. Allen Ligon^1,*, Larry A. Latson¹, Mark M. Ruzmetov², Kak-Chen Chan¹, Todd Roth¹, Immanuel I. Turner², Frank G. Scholl², Steve Bibevski²

1 The Pediatric Heart Institute, Joe DiMaggio Children’s Hospital, Memorial Regional Hospital-Memorial Healthcare System, Hollywood, Florida, USA
2 Division of Congenital Cardiothoracic Surgery, The Pediatric Heart Institute, Joe DiMaggio Children’s Hospital, Florida, USA

* Corresponding Author: R. Allen Ligon. Email:

Congenital Heart Disease 2021, 16(3), 285-297. https://doi.org/10.32604/CHD.2021.014373

Received 22 September 2020; Accepted 23 October 2020; Issue published 02 March 2021

Abstract

Background: Pulmonary valve replacement (PVR) can be accomplished via surgical, transcatheter, or hybrid approaches. There are inherent advantages to transcatheter PVR and hybrid PVR without cardiopulmonary bypass. We review the methods and results of a standardized institutional approach to PVR. Methods: Retrospective review of all PVR cases between February 2017 and February 2020. Hybrid PVR entailed off-pump RVOT plication with percutaneous transcatheter PVR. Results: Primary transcatheter PVR was attempted in 37, hybrid PVR was performed in 11, and on-pump surgical PVR was performed in 9. Median age at PVR was 27 years (6–65). Primary transcatheter PVR was successful in 35/37 (2 converted to surgical). Standard surgical PVR was utilized for positive coronary compression testing (n = 4), stent/valve system migration (n = 2), or patient preference (n = 3). In the hybrid group mean RVOT diameter was 34 mm (32–38). Median length of stay was 1 day for transcatheter PVR, 5 for surgical, and 3 for hybrid (p = 0.02). Median follow-up was 1.5 years. Re-interventions were one balloon valve dilation in a transcatheter PVR, and one valve dilation with subsequent transcatheter valve-in-valve PVR in the surgical cohort. One hybrid patient expired 11 months post procedure. Conclusions: A systematic approach to PVR utilizing all approaches in pre-defined order of preference leads to consistent outcomes in a wide variety of anatomic configurations. Transcatheter PVR may be accomplished in the majority of patients. When necessary, hybrid off-pump RVOT plication with transcatheter PVR avoids the need for cardiopulmonary bypass.

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