title: Rescue surgery following percutaneous pulmonary valve implantation.
abstract: OBJECTIVE
  Percutaneous pulmonary valve insertion (PPVI) is an evolving alternative to surgical pulmonary valve insertion. The aim of this study is to review the acute complications of PPVI requiring emergency rescue surgery.
  
  
  METHODS
  Between 09/2000 and 01/2007, 152 patients (pts), received a PPVI. Patient's charts were reviewed in retrospect.
  
  
  RESULTS
  Emergency rescue surgery (ERS) took place in 6 pts (3.9%). Indications for ERS were: homograft rupture two pts, dislodgment of the stented valve in a dilated right ventricular outflow tract two pts, occlusion of the right pulmonary artery one pt and compression of the left main coronary artery one pt. Cardiopulmonary bypass was established through repeat sternotomy incision with femorofemoral cannulation in 2/6 pts. The stented valve was removed in five and replaced with a homograft in three and a valved conduit in two pts. One ruptured homograft was repaired leaving the stented valve in situ. All patients survived, one sustained mild neurological impairment.
  
  
  CONCLUSIONS
  Although some of the acute complications of PPVI were probably related to a learning curve (4 among the first 50 pts and 2 among the last 102 patients) the need for ERS is unlikely to be completely abolished. This experience highlights the importance of close collaboration between cardiologists and surgeons in these evolving technologies. Highly skilled and responsive surgical back up is necessary to support the introduction and to sustain institutional programmes such as PPVI.
authors.affiliation: Cardiac Unit, Great Ormond Street Hospital for Children, NHS Trust, Great Ormond Street, WC1N 3JH London, United Kingdom.
authors.forename: Martin
authors.initials: M
authors.lastname: Kostolny
authors.forename: Victor
authors.initials: V
authors.lastname: Tsang
authors.forename: Johannes
authors.initials: J
authors.lastname: Nordmeyer
authors.forename: Carin
authors.initials: C
authors.lastname: Van Doorn
authors.forename: Alessandra
authors.initials: A
authors.lastname: Frigiola
authors.forename: Sachin
authors.initials: S
authors.lastname: Khambadkone
authors.forename: Marc R
authors.initials: MR
authors.lastname: de Leval
authors.forename: Philipp
authors.initials: P
authors.lastname: Bonhoeffer
mesh_terms: D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass / Q000379:methods*; D013504:Cardiovascular Surgical Procedures / Q000379:methods / Q000639:trends; D002648:Child; D004630:Emergencies; D005260:Female; D006349:Heart Valve Diseases / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D011183:Postoperative Complications / Q000503:physiopathology / Q000601:surgery*; D011664:Pulmonary Valve / Q000502:physiology / Q000601:surgery*; D016879:Salvage Therapy / Q000379:methods*; D014184:Transplantation, Homologous