Left Anterior Mini-Incision for Pulmonary Valve Replacement Following Tetralogy of Fallot Repair

Nellis, Joseph R.; Vekstein, Andrew M.; Meza, James M.; Andersen, Nicholas D.; Haney, John C.; Turek, Joseph W.

doi:10.1177/1556984520911025

Cited by 9 publications

(15 citation statements)

References 17 publications

(16 reference statements)

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“…Vekstein et al 13 reported LAMI in a 12‐year‐old male with TOF. We agree with others that patients who are candidates for this procedure should be at least 30 kg in weight to allow safe groin vessel cannulation 12 . These patients are young with normal aorta and peripheral vasculature, which allow safe utilization of peripheral cannulation for CPB.…”

Section: Discussionsupporting

confidence: 71%

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

et al. 2021

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

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Section: Discussionsupporting

confidence: 71%

“…Nellis et al 12 have recently reported a series of seven patients with the previous repair of TOF who underwent LAMI for PVR with excellent results. The authors' median CPB time was 2.5 h, and two patients experienced early complications.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2021

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“…In our opinion, surgical closure from LALT is preferred in such patient groups. Recently, this LALT incision was also applied to replace pulmonary valve in 7 patients following Tetralogy of Fallot repair by Nellis et al (23) The lower weight limit of femoral cannulation is inconsistent. Most surgeons prefer using peripheral cannulation in patients over 30 kg; however, surgeons from Switzerland dissected iliac artery in infants with body weight as low as 10 kg.…”

Section: Discussionmentioning

confidence: 99%

Individualized Strategy of Minimally Invasive Cardiac Surgery in Congenital Cardiac Septal Defects

Zhu¹,

Zhang²,

Bao³

et al. 2021

Preprint

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Background: Intracardiac septal defect tends to be repaired by minimally invasive surgery in both children and adults. This study summarized our strategy of minimally invasive therapy using various lateral mini-thoracotomies in patients with congenital septal defect. Methods: Four hundred and seventy-two patients who underwent minimally invasive repair of intracardiac septal defects (Atrial septal defect, ASD; ventricular septal defect, VSD; atrioventricular septal defect, AVSD) between January 2012 and June 2020 were retrospectively reviewed. Those who underwent device closure were excluded. The minimally invasive strategy included three groups. First, right sub-axillary vertical incision group (RSAVI group, N=335, 192 ASDs, 135 VSDs and 8 AVSDs; Second, right anterolateral thoracotomy group (RALT group, N=132, 77 ASDs, 51 VSDs and 4 AVSDs; Third, left anterolateral thoracotomy group (LALT group, N=5, all of them were sub-pulmonary VSDs).Results: Concomitant surgeries included 9 cases of right ventricular outflow tract obstruction relief, 9 mitral repairs and 37 tricuspid repairs. There was one transition from thoracotomy to sternotomy. Three patients required second pump run for residual lesions (2 residual shunts and 1 mitral regurgitation). The age and body weight of RSAVI group were significantly lower than those of RALT and LALT groups. The mean cardiopulmonary bypass time was 67.3±11.3 min and cross clamp time was 38.1±8.9 min. There was no post-operative death, and complications included 1 chest exploration for bleeding, 1 redo operation due to patch dehiscence during the same admission, 1 transient neural dysfunction, 3 diaphragmatic paresis and 13 atelectasis. The median stay in ICU was 2 days, while the median post-operative hospitalization was 6 days. The echocardiography results before discharge indicated no significant residual lesions. There was no reoperation, no new onset of chest deformities and no sclerosis during the follow up. Conclusions: The commonly seen intracardiac septal defects can be safely and effectively repaired by minimally invasive surgery with good cosmetic results. Right sub-axillary vertical incision is suitable in infants and young children, while right anterior mini-thoracotomy is more commonly used in adolescents and adults. Left anterior mini-thoracotomy is an alternative incision to repair sub-pulmonary artery VSD.

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“…Since late 2018, our group has performed 19 operations, including 14 redo PVRs following primary tetralogy of Fallot repair, through a 5-cm left anterior mini-incision. 3,4 In our series, the median age for patients undergoing left anterior mini-incision was 16 years old (13-23 years) with a median body mass index of 20 (19-29). Two patients with body mass indexes of>30 and multiple previous median sternotomies were converted to sternotomy due to dense adhesions and inadequate exposure.…”

mentioning

confidence: 81%

Commentary: Minimally invasive pulmonary valve replacement and the adoption curve for novel techniques

2021

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Left Anterior Mini-Incision for Pulmonary Valve Replacement Following Tetralogy of Fallot Repair

Cited by 9 publications

References 17 publications

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

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

Individualized Strategy of Minimally Invasive Cardiac Surgery in Congenital Cardiac Septal Defects

Commentary: Minimally invasive pulmonary valve replacement and the adoption curve for novel techniques

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