摘要
Background:Pulmonary valve replacement(PVR)can be accomplished via surgical,transcatheter,or hybrid approaches.There are inherent advantages to transcatheter PVR and hybrid PVR without cardiopulmonary bypass.We review the methods and results of a standardized institutional approach to PVR.Methods:Retrospective review of all PVR cases between February 2017 and February 2020.Hybrid PVR entailed off-pump RVOT plication with percutaneous transcatheter PVR.Results:Primary transcatheter PVR was attempted in 37,hybrid PVR was performed in 11,and on-pump surgical PVR was performed in 9.Median age at PVR was 27 years(6–65).Primary transcatheter PVR was successful in 35/37(2 converted to surgical).Standard surgical PVR was utilized for positive coronary compression testing(n=4),stent/valve system migration(n=2),or patient preference(n=3).In the hybrid group mean RVOT diameter was 34 mm(32–38).Median length of stay was 1 day for transcatheter PVR,5 for surgical,and 3 for hybrid(p=0.02).Median follow-up was 1.5 years.Re-interventions were one balloon valve dilation in a transcatheter PVR,and one valve dilation with subsequent transcatheter valve-in-valve PVR in the surgical cohort.One hybrid patient expired 11 months post procedure.Conclusions:A systematic approach to PVR utilizing all approaches in pre-defined order of preference leads to consistent outcomes in a wide variety of anatomic configurations.Transcatheter PVR may be accomplished in the majority of patients.When necessary,hybrid off-pump RVOT plication with transcatheter PVR avoids the need for cardiopulmonary bypass.
