Hybrid Approach for Off-Pump Pulmonary Valve Replacement in Patients With a Dilated Right Ventricular Outflow Tract

We describe a hybrid method for minimally invasive pulmonary valve replacement without the use of cardiopulmonary bypass in 3 patients with high surgical risk and dilated right ventricular outflow tracts incompatible with currently available transcatheter devices. This procedure entails surgical creation of a landing zone in the main pulmonary artery through an anterior thoracotomy, followed by transcatheter Melody valve pulmonary valve replacement. Particularly in high-risk patients, this approach may limit morbidity and mortality associated with traditional surgical pulmonary valve replacement.