title: Hybrid pulmonary artery plication followed by transcatheter pulmonary valve replacement: Comparison with surgical PVR.
abstract: Objective/Background Historically, the sole option for patients with a dysfunctional native right ventricular outflow tract (RVOT) requiring re-establishment of pulmonary competence has been surgical PVR. We sought to compare early outcomes of hybrid pulmonary valve replacement (PVR) combining surgical plication of the main pulmonary artery followed by transcatheter PVR, with a contemporary cohort of surgical PVR patients. Methods Retrospective chart analysis of all patients with a dilated native RVOT eligible for surgical PVR over 36 months was performed. The cohorts included patients with previous tetralogy of Fallot repair (n = 14), and previous intervention for congenital abnormality of the pulmonary valve (n = 7). Results Twenty-one patients with a dysfunctional native RVOT met criteria for PVR; 8 using the hybrid procedure (group 1: age, 31.5 +/- 17.4 years) and 13 with cardiopulmonary bypass (CPB) (group 2: age, 31 +/- 18.4 years). Valve delivery was successful in all patients with no procedural mortality. Group 1 had a lesser requirement for blood products (P =< 0.001) and a trend toward shorter hospital stay and higher post-operative hemoglobin. No patients in group 1 received inotropic support post-operatively compared to 54% of patients in group 2. Mean follow-up was 3.4 months for group 1 and 13.6 months for group 2 with the average peak gradient across the RVOT of 20.1 and 15.1 mm Hg respectively (P = 0.12), all with no more than mild PI. Conclusions Transcatheter hybrid PVR following RVOT plication provides a reasonable alternative to surgical PVR particularly in higher risk cohorts, reducing possible longer-term consequences of repeated runs of CPB. © 2016 Wiley Periodicals, Inc.
authors.affiliation: Rush Center for Congenital Heart Disease, Rush University Medical Center, Chicago, Illinois.
authors.forename: Cyndi
authors.initials: C
authors.lastname: Sosnowski
authors.affiliation: Rush Center for Congenital Heart Disease, Rush University Medical Center, Chicago, Illinois.
authors.forename: Thomas
authors.initials: T
authors.lastname: Matella
authors.affiliation: Rush Center for Congenital Heart Disease, Rush University Medical Center, Chicago, Illinois.
authors.forename: Louis
authors.initials: L
authors.lastname: Fogg
authors.affiliation: Rush Center for Congenital Heart Disease, Rush University Medical Center, Chicago, Illinois.
authors.forename: Michel
authors.initials: M
authors.lastname: Ilbawi
authors.affiliation: Nebraska Heart Institute, Lincoln, Nebraska.
authors.forename: Hosakote
authors.initials: H
authors.lastname: Nagaraj
authors.affiliation: Rush Center for Congenital Heart Disease, Rush University Medical Center, Chicago, Illinois.
authors.forename: Clifford
authors.initials: C
authors.lastname: Kavinsky
authors.affiliation: Department of Cardiology, Our Lady's Children's Hospital, Dublin, Ireland.
authors.forename: Andrew R
authors.initials: AR
authors.lastname: Wolf
authors.affiliation: Rush Center for Congenital Heart Disease, Rush University Medical Center, Chicago, Illinois.
authors.forename: Karim
authors.initials: K
authors.lastname: Diab
authors.affiliation: Bristol Heart Institute, Bristol Royal Infirmary, Bristol, UK.
authors.forename: Massimo
authors.initials: M
authors.lastname: Caputo
authors.affiliation: Department of Cardiology, Our Lady's Children's Hospital, Dublin, Ireland.
authors.forename: Damien
authors.initials: D
authors.lastname: Kenny
mesh_terms: D000293:Adolescent; D000328:Adult; D000792:Angiography; D001705:Bioprosthesis; D006328:Cardiac Catheterization / Q000379:methods*; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006801:Humans; D008297:Male; D008875:Middle Aged; D011651:Pulmonary Artery / Q000000981:diagnostic imaging / Q000601:surgery*; D011664:Pulmonary Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D011665:Pulmonary Valve Insufficiency / Q000175:diagnosis / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods*; D055815:Young Adult
keywords: Tetralogy of Fallot; hybrid pulmonary valve replacement; melody valve; pulmonary valve replacement