Utility Of The Left Anterior Mini-Thoracotomy In Congenital Heart Disease Involving The Pulmonary Artery
Zachary W. Fitch1, Alyssa Habermann1, James M. Meza1, Jude S. Sauer2, Nicholas D. Andersen1, John C. Haney1, Joseph W. Turek1.
1Duke University, Durham, NC, USA, 2LSI Solutions, Victor, NY, USA.
Background: In congenital heart disease patients, access to the pulmonary artery and pulmonary valve has traditionally been accomplished via median sternotomy or thoracotomy. Given the complex anatomy involved in congenital heart surgery and the frequent need for re-do surgery, a minimally invasive approach to the pulmonary artery is desirable. Objective: We devised a minimally invasive and less morbid surgical approach to the pulmonary artery utilizing a mini-thoracotomy and an innovative surgical device. Methods: Peripheral arterial cannulation and dual peripheral venous cannulation utilizing the femoral and internal jugular veins is employed. A left-sided 5cm transverse, rib-sparing mini-thoracotomy is placed in either the 3rd intercostal space for pulmonary valve access or the 2nd intercostal space for distal pulmonary artery access. For pulmonary valve replacement (PVR) an automated dual curved needle suturing device is used to place 3.5mm wide horizontal mattress sutures along the posterior wall while the rest of the procedure uses hand-sewn technique and an anterior pulmonary artery polytetrafluoroethylene (PTFE) patch to augment the right ventricular outflow tract. Results: Our mini-thoracotomy approach was initiated in July 2018 and to date has been used in seven patients, all males so far and ranging in age from 12 to 48 years. We have performed four successful PVRs, one PVR which was converted to an open procedure, one plication of the main pulmonary artery for Melody valve deployment, and one pulmonary artery translocation for anomalous aortic origin of the left coronary artery. Conclusions: Our approach provides a safe, versatile, and less morbid method for surgically accessing the pulmonary artery and pulmonary valve.
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