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Transcatheter Pulmonary Valve Replacement from Autologous Pericardium with a Self-Expandable Nitinol Stent in an Adult Sheep Model
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Pulmonary valve replacement in older children and adults using stented bioprostheses

Fredrik Halvorsen1, Christoph Haller1, Edward Hickey2

  • 1Labatt Family Heart Centre, Division of Cardiovascular Surgery, The Hospital for Sick Children, Toronto, Canada.

Multimedia Manual of Cardiothoracic Surgery : MMCTS
|July 13, 2016
PubMed

Insights

Pulmonary valve replacement (PVR) is often needed for adults with repaired tetralogy of Fallot (TOF) due to pulmonary regurgitation. This summary details a surgical approach for this high-stakes redo cardiac surgery.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Pediatric Heart Surgery

Background:

  • Tetralogy of Fallot (TOF) repair using a transannular patch frequently leads to pulmonary regurgitation.
  • Over 50% of TOF repair patients require pulmonary valve replacement (PVR) in early adulthood.
  • Progressive right ventricular (RV) dilatation from pulmonary regurgitation can cause RV dysfunction, exercise intolerance, and arrhythmias.

Purpose of the Study:

  • To describe the surgical approach for pulmonary valve replacement (PVR) in adults with previously repaired tetralogy of Fallot (TOF).
  • To outline strategies for managing this high-stakes redo cardiac surgery in a specialized center.

Main Methods:

  • Review of surgical approach for >1000 pulmonary valve replacement (PVR) cases in patients with repaired tetralogy of Fallot (TOF).
  • Focus on techniques for managing redo sternotomy and complex valve replacement in adult patients.

Main Results:

  • Pulmonary valve replacement (PVR) is crucial for mitigating right ventricular (RV) dilatation and dysfunction in adults with repaired tetralogy of Fallot (TOF).
  • Asymptomatic patients often require PVR due to the risk of future RV failure or ventricular tachyarrhythmia.
  • Redo cardiac surgery for PVR in this population presents significant challenges but is manageable with experienced surgical teams.

Conclusions:

  • Pulmonary valve replacement (PVR) is essential for long-term outcomes in adults with tetralogy of Fallot (TOF) repaired with a transannular patch.
  • Careful surgical planning and execution are vital for successful redo cardiac surgery in this patient cohort.
  • This approach aims to improve RV function, reduce symptoms, and prevent life-threatening complications.

Keywords:
Pulmonary valve replacementTetralogy of Fallot

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