International Society for Minimally Invasive Cardiothoracic Surgery
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Minimally Invasive Surgery For Pulmonary Valve Replacement-case Series-10 Patients
WINN M M AYE, SENTHIL K. SUBBIAN, TING T. LOW, THEODOROS KOFIDIS, LASZLO KIRALY.
NATIONAL UNIVERSITY HOSPITAL, NATIONAL UNIVERSITY HEALTH SYSTEM, SINGAPORE, Singapore.

BACKGROUND: The Tetralogy of Fallot (ToF) repair is usually performed in early childhood. Pulmonary valve regurgitation (PR) results in dilated Right Ventricle (RV) that necessitates pulmonary valve replacement (PVR) in the adulthood. The conventional surgical approach for PVR is via Redo-Median-Sternotomy. We investigated feasibility and safety of PVR with minimally invasive approach. METHODS: Preoperative investigations are routinely performed for all the patients: Transthoracic 2D Echocardiogram(2D ECHO), Cardiac MRI, 24 hour Holter Monitor, Cardiopulmonary Exercise Testing, CT-Thorax, Abdomen and Pelvis with contrast and Doppler Ultrasound of the groin vessels. Minimally Invasive Surgical approach was applied through Left Anterior Mini-Thoracotomy entering the thoracic cavity via 2nd or 3rd Intercostal space. Cardiopulmonary bypass was established through the groin vessels.
RESULTS: Ten patients underwent Minimally Invasive Surgery for PVR (MIS PVR) via Left Anterior Mini-Thoracotomy from January 2015 to August 2022. The demographic and clinical outcomes are as follows: Age: 32.27 11.6 ( 24.25 - 64.17 ) years; Right Ventricular End Diastolic Volume Index (RVEDVI) : 184.2 41.98 (133 - 275) ml/m2; Right Ventricular Ejection Fraction (RVEF): 45.5 10.53 (28-50)%; Incision Length: 7.79 0.53 (7-9)cm; CardioPulmonary Bypass time: 2.48 0.66 (1.4 - 2.85) hours ; Post-operative ventilator hours : 7.96 4.34 ( 4.65 - 10.8 ) hours; ICU stay : 1 0 days ; HDU stay: 1 0.47 (1 -2 ) days; Chest Drain removed - Post operative days: 3.1 0.99 ( 2 - 5) days and Length of stay in Hospital : 4.8 1.75 (3 - 8) days. Postoperative 2D ECHO performed prior to discharge showed 3 patients with no PR, 1 patient with trivial PR and 6 patients with mild PR.
CONCLUSIONS: All 10 patients were discharged home without any complications. They were back to regular active life style within 2 weeks after discharge from hospital. MIS PVR is safe and effective and it should be considered as preferred surgical approach for PVR following ToF repair.


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