Pulmonary valve implantation using self-expanding tissue valve without cardiopulmonary bypass reduces operation time and blood product use.
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.
Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom. Electronic address: qiangchen79@hotmail.com.
Qiang
Q
Chen
Department of Cardiology, Bristol Heart Institute, Bristol, United Kingdom.
Mark
M
Turner
Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom.
Massimo
M
Caputo
Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom.
Serban
S
Stoica
Paediatric Heart Institute, Hospital 12 de Octubre, Madrid, Spain.
Stefano
S
Marianeschi
Department of Cardiac Surgery, Bristol Royal Hospital for Children, Bristol, United Kingdom.
Andrew
A
Parry
D000293:Adolescent; D000328:Adult; D002315:Cardiopulmonary Bypass; D002648:Child; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008875:Middle Aged; D011474:Prosthesis Design; D011664:Pulmonary Valve / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000601:surgery*; D012189:Retrospective Studies; D055815:Young Adult