Pulmonary valve replacement via left anterior minithoracotomy: Lessons learned and early experience

• DOI: 10.1111/jocs.15382
• Publication Date: 2021-02-06T09:01:45Z
• Authors: Sameh M. Said; Gamal Marey; Gurumurthy Hiremath; Varun Aggarwal; Benjamin Kloesel; Massimo Griselli
• Keywords: Thoracotomy; Median sternotomy; Pulmonary atresia; Concomitant

Objective Median sternotomy has been the standard for pulmonary valve replacement (PVR) in patients with free regurgitation (PR) and right ventricular enlargement. With introduction of transcatheter therapy, search an alternate to is mandated. We present our early experience a limited anterior left thoracotomy approach. Methods used mini-thoracotomy six male (15 ± 1.94 years age) who developed progressive enlargement due chronic PR. Results Primary diagnoses were tetralogy Fallot five atresia intact septum another. Four had previous median transannular patch repair. The mean end-diastolic volume index was 189 27.13 ml/m2. procedure feasible all patients. All satisfactory adult size bioprosthesis (25 or 27 mm valve), peak gradient 18 2.40 mmHg across prosthesis at discharge. extubated intraoperatively end required no intraoperative transfusions. There late mortalities. Early morbidities included hemidiaphragm paralysis one patient, re-sternotomy prosthetic endocarditis one. One patient reoperation common femoral artery pseudoaneurysm. Conclusions Minimally invasive access PVR both primary repeat settings, through minithoracotomy absence intracardiac shunts need other concomitant cardiac procedures. Longer-term studies larger number are needed compare efficacy this approach sternotomy.