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Procedural technique for hybrid pulmonary valve replacement in infants and small children
Colm R Breatnach1, Jonathan McGuinness2, Li Yen Ng1
1Department of Cardiology, Children's Health Ireland at Crumlin, Dublin, Ireland.
Insights
Hybrid pulmonary valve replacement (PVR) in infants and small children shows high success without mortality. This review details various approaches for complex pediatric cases, highlighting the feasibility of this innovative technique.
Area of Science:
- Pediatric Cardiology
- Cardiovascular Surgery
- Interventional Cardiology
Background:
- Data on hybrid pulmonary valve replacement (PVR) in infants and small children is limited.
- Various hybrid PVR strategies are emerging for the pediatric population.
- This study reviews a hybrid PVR strategy in a complex pediatric cohort.
Purpose of the Study:
- To review the hybrid PVR strategy in a complex pediatric patient cohort.
- To outline the variety of approaches employed in a single tertiary cardiology center.
- To assess the feasibility and outcomes of hybrid PVR in infants and small children.
Main Methods:
- Retrospective review of infants and small children undergoing hybrid PVR (May 2017 - April 2019).
- Analysis of demographic, clinical, and outcome data from medical records.
- Inclusion of patients managed with perventricular or surgically sutured valve approaches.
Main Results:
- Ten pediatric patients (median age 1.5 years) underwent successful hybrid PVR with no mortality.
- Pventricular approaches (sternotomy/subxiphoid) were used in 8 patients; 2 had surgically sutured valves.
- Complications included paravalvar leak (2), suspected endocarditis (1), and wound infection (1).
Conclusions:
- Hybrid PVR can be employed in small children with a high success rate.
- Various approaches to hybrid PVR are feasible in this complex pediatric population.
- Longer-term follow-up studies are needed to compare durability with standard surgical replacement.
Objectives:
Hybrid approach to pulmonary valve replacement (PVR) in the paediatric population has been reported, although data in infants and small children are limited. Several strategies are now possible. The aim of this study is to review our hybrid PVR strategy in a complex patient cohort, outlining a variety of approaches employed in our centre.
Methods:
We performed a retrospective review of infants and small children who underwent hybrid PVR between May 2017 and April 2019 in a single tertiary cardiology centre. Medical records were reviewed to ascertain demographic, clinical and outcome data.
Results:
Ten patients with a median (interquartile range) age of 1.5 years (1.1-1.9) and weight of 8.8 kg (8-10.6) were managed with hybrid pulmonary valve insertion. Eight patients had perventricular approach (4 sternotomy and 4 subxiphoid) and 2 patients had surgically sutured valve. Six patients underwent cardiopulmonary bypass for associated lesions. Three had insertion of the valve into conduits and 7 were deployed into native right ventricular outflow tracts. The pulmonary valve was successfully inserted in all 10 patients with no mortality. Postprocedural complications included paravalvar leak in 2 patients, suspected endocarditis in 1 patient who developed early valve regurgitation and wound infection in 1 patient.
Conclusions:
Several approaches to hybrid PVR may be employed in small children with a high success rate. Follow-up studies are required to evaluate longer term durability of these approaches compared to standard surgical replacement.
