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OBJECTIVE: Newly developed self-expanding tissue valves allow surgical implantation of a pulmonary valve without using cardiopulmonary bypass. We reviewed our initial experience, the first in the UK, with this new technique and compared outcomes with the conventional approach.
METHODS: Thirteen symptomatic patients with severe pulmonary regurgitation underwent pulmonary valve implantation, 6 without (group 1, age 28±21 years; range, 12 to 62, BSA range 1.38 - 2.39 m2) and 7 with cardiopulmonary bypass (group 2, age 24±14 years; range, 12 to 46, BSA range 1.31 - 1.89 m2). Ten had previous repair of Tetralogy Fallot and 3 pulmonary valvotomy / valvuloplasty.
RESULTS: Median operation times were 166 minutes (range, 110 to 240) in group 1 and 299 minutes (range, 221 to 375) in group 2 (p<0.001). Haemoglobin level after chest closure was 13.4 g/dL in group 1 and 9.8 g/dL in group 2, (p<0.001). Post-operative chest drainage was 77.5 mls in group 1 and 300 mls in group 2, (p=0.003). Blood product requirement was none in group 1 and 3 units in group 2, (p<0.014). There was no significant difference in postoperative ventilation time, length of ICU and hospital stay between the two groups. Median follow-up was 15 months, all patients are in NYHA I/II. Echocardiography showed peak velocity across the pulmonary valve was 2.2 m/s in group 1 and 2.0 m/s in group 2, (p=0.46). 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. It reduces operating time, blood loss and blood products requirement.