Key result
Hybrid pulmonary valve replacement using pulmonary artery banding via left anterior thoracotomy and transvenous SAPIEN S3 valve placement was successfully performed in two patients.
Why the study?
Many patients with repaired congenital heart disease requiring reintervention on dysfunctional right ventricular outflow tracts are poor candidates for both transcatheter pulmonary valve replacement and cardiopulmonary bypass.
Case Report (n=2)
A hybrid approach combining left anterior thoracotomy for pulmonary artery banding with transvenous transcatheter pulmonary valve replacement is feasible for high-risk patients with repaired congenital heart disease, avoiding the need for cardiopulmonary bypass and redo sternotomy.
Hybrid approaches may expand options for high-risk congenital patients ineligible for standard therapies; leaves open need for prospective safety and durability data.
For many patients with repaired congenital heart disease, the need for reintervention on dysfunctional right ventricular outflow tracts is pervasive. Many such patients are poor candidates for both transcatheter pulmonary valve replacement and cardiopulmonary bypass, and hybrid surgical and transcatheter procedures have evolved to meet this need. We present two cases of hybrid pulmonary valve replacement involving pulmonary artery band placement via left anterior thoracotomy followed by transvenous placement of a SAPIEN S3 valve without prestenting. This approach avoids cardiopulmonary bypass as well as redo sternotomy and will likely see an increase in utilization in the future.
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Serfas et al. (2019) conducted a case report in Dysfunctional right ventricular outflow tracts in repaired congenital heart disease (n=2). Hybrid pulmonary valve replacement (pulmonary artery band placement and transvenous SAPIEN S3 valve) was evaluated. Hybrid pulmonary valve replacement using pulmonary artery banding via left anterior thoracotomy and transvenous SAPIEN S3 valve placement was successfully performed in two patients.
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