Pulmonary insufficiency is a known complication following Tetralogy of Fallot repair. With over 90% of patients now surviving to adulthood, surgeons are once again faced with the question of when, and more importantly, how to reintervene. We developed a novel approach to pulmonary valve replacement in this population through a 5-cm left anterior mini-incision. The incision is optimized for exposing and operating on the right ventricular outflow tract and the main pulmonary artery in patients with a history of median sternotomy. Early outcomes are reassuring, and we believe our approach is a safe and reliable alternative to median sternotomy within this patient population, with the ability to quickly convert intraoperatively when needed.
GatzoulisMA.BalajiS.WebberSAet al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet2000; 356: 975–981.doi:10.1016/S0140-6736(00)02714-8
3.
ValenteAM.GauvreauK.AssenzaGEet al. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart2014; 100: 247–253.doi:10.1136/heartjnl-2013-304958
4.
CuypersJAAE.MentingME.KoningsEEMet al. Unnatural history of tetralogy of Fallot: prospective follow-up of 40 years after surgical correction. Circulation2014; 130: 1944–1953.doi:10.1161/CIRCULATIONAHA.114.009454
5.
HickeyEJ.VeldtmanG.BradleyTJet al. Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J Cardiothorac Surg2009; 35: 156–164.doi:10.1016/j.ejcts.2008.06.050
6.
DennisM.MooreB.KotchetkovaIet al. Adults with repaired tetralogy: low mortality but high morbidity up to middle age. Open Heart2017; 4: e000564.doi:10.1136/openhrt-2016-000564
7.
HolstKA.DearaniJA.BurkhartHMet al. Risk factors and early outcomes of multiple reoperations in adults with congenital heart disease. Ann Thorac Surg2011; 92: 122–130.doi:10.1016/j.athoracsur.2011.03.102
8.
ParkCB.SuriRM.BurkhartHMet al. Identifying patients at particular risk of injury during repeat sternotomy: analysis of 2555 cardiac reoperations. J Thorac Cardiovasc Surg2010; 140: 1028–1035.doi:10.1016/j.jtcvs.2010.07.086
9.
KirshbomPM.MyungRJ.SimsicJMet al. One thousand repeat sternotomies for congenital cardiac surgery: risk factors for reentry injury. Ann Thorac Surg2009; 88: 158–161.doi:10.1016/j.athoracsur.2009.03.082
10.
GiambertiA.ChessaM.AbellaRet al. Morbidity and mortality risk factors in adults with congenital heart disease undergoing cardiac reoperations. Ann Thorac Surg2009; 88: 1284–1289.doi:10.1016/j.athoracsur.2009.05.060
11.
DosL.DadashevA.TanousDet al. Pulmonary valve replacement in repaired tetralogy of Fallot: determinants of early postoperative adverse outcomes. J Thorac Cardiovasc Surg2009; 138: 553–559.doi:10.1016/j.jtcvs.2009.02.042
12.
LurzP.CoatsL.KhambadkoneSet al. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation2008; 117: 1964–1972.doi:10.1161/CIRCULATIONAHA.107.735779
13.
ArmstrongAK.BalzerDT.CabalkaAKet al. One-year follow-up of the Melody transcatheter pulmonary valve multicenter post-approval study. JACC Cardiovasc Interv2014; 7: 1254–1262.doi:10.1016/j.jcin.2014.08.002http://www.ncbi.nlm.nih.gov/pubmed/25459038
14.
CheathamJP.HellenbrandWE.ZahnEMet al. Clinical and hemodynamic outcomes up to 7 years after transcatheter pulmonary valve replacement in the US Melody valve investigational device exemption trial. Circulation2015; 131: 1960–1970.doi:10.1161/CIRCULATIONAHA.114.013588
15.
Van DijckI.BudtsW.CoolsBet al. Infective endocarditis of a transcatheter pulmonary valve in comparison with surgical implants. Heart2015; 101: 788–793.doi:10.1136/heartjnl-2014-306761
16.
UebingA.RigbyML. The problem of infective endocarditis after transcatheter pulmonary valve implantation. Heart2015; 101: 749–751.doi:10.1136/heartjnl-2014-307287
17.
McElhinneyDB.BensonLN.EickenAet al. Infective endocarditis after transcatheter pulmonary valve replacement using the Melody valve: combined results of 3 prospective North American and European studies. Circ Cardiovasc Interv2013; 6: 292–300.doi:10.1161/CIRCINTERVENTIONS.112.000087
