HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Sachin Khambadkone Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Boudjemline, Y. Articles by Bonhoeffer, P. Search for Related Content PubMed PubMed Citation Articles by Boudjemline, Y. Articles by Bonhoeffer, P. Related Collections Congenital - acyanotic Congenital - cyanotic Minimally invasive surgery Valve disease

J Thorac Cardiovasc Surg 2005;129:831-837
© 2005 The American Association for Thoracic Surgery

Evolving Technology

Off-pump replacement of the pulmonary valve in large right ventricular outflow tracts: A hybrid approach

^a Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, Paris, France
^b Institut National de la Santé et de la Recherche Médicale EMIU 0016, Faculté de Necker Enfants Malades, Paris, France
^c Cardiothoracic Unit, Great Ormond Street Hospital, London, United Kingdom

Received for publication August 31, 2004; revisions received October 19, 2004; accepted for publication October 28, 2004.

^_* Address for reprints: Younes Boudjemline, MD, Service de Cardiologie Pédiatrique, Hôpital Necker Enfants Malades, 149 rue de Sèvres, 75015 Paris Cedex, France (E-mail: younes.boudjemline{at}nck.ap-hop-paris.fr).

BACKGROUND: Percutaneous pulmonary valve replacement has recently been introduced and is under investigation in humans. This technique is, however, limited to patients with a right ventricular outflow tract that does not exceed 22 mm in diameter. We report our experience of off-pump pulmonary valve replacement using a hybrid approach in animals with large right ventricular outflow tracts.

METHODS: Eight ewes were included in the protocol and were equally divided into 2 groups. A left thoracotomy was first performed, and the main pulmonary artery was banded by using 2 radiopaque rings with a diameter of 18 mm that allowed for further pulmonary valve replacement. We then intended to implant a valved stent either percutaneously (group 1) or through a transventricular approach (group 2). All animals were killed after valve implantation. The operation allowed the pulmonary diameter to be reduced from 30 to 17.6 mm.

RESULTS: The right ventricular pressure did not significantly increase after reduction of the pulmonary artery diameter (25 vs 36 mm Hg). Subsequent pulmonary valve replacement through a percutaneous or a transventricular approach was always possible without any requirement for extracorporeal circulation. All devices were successfully delivered inside the pulmonary artery banding and were functioning perfectly at early evaluation.

CONCLUSIONS: Implantation of a pulmonary valve is possible in ewes through a hybrid approach when the right ventricular outflow tract exceeds 22 mm in diameter. This involves both surgeons and interventionists and allows for a staged procedure in which the valvulation is performed percutaneously or, for a combined hybrid approach, in which the valve is implanted off pump transventricularly during the same operation.

This article has been cited by other articles:

				J. D. Robb, M. A. Harris, M. Minakawa, E. Rodriguez, K. J. Koomalsingh, T. Shuto, D. C. Shin, Y. Dori, A. C. Glatz, J. J. Rome, et al. Melody Valve Implantation Into the Branch Pulmonary Arteries for Treatment of Pulmonary Insufficiency in an Ovine Model of Right Ventricular Outflow Tract Dysfunction Following Tetralogy of Fallot Repair Circ Cardiovasc Interv, February 1, 2011; 4(1): 80 - 87. [Abstract] [Full Text] [PDF]

				A. Metzner, K. Iino, U. Steinseifer, A. Uebing, W. de Buhr, J. Cremer, and G. Lutter Percutaneous pulmonary polyurethane valved stent implantation J. Thorac. Cardiovasc. Surg., March 1, 2010; 139(3): 748 - 752. [Abstract] [Full Text] [PDF]

				F. Godart, I. Bouzguenda, F. Juthier, F. Wautot, A. Prat, C. Rey, D. Corseaux, A. Ung, B. Jude, and A. Vincentelli Experimental off-pump transventricular pulmonary valve replacement using a self-expandable valved stent: A new approach for pulmonary incompetence after repaired tetralogy of Fallot? J. Thorac. Cardiovasc. Surg., May 1, 2009; 137(5): 1141 - 1145. [Abstract] [Full Text] [PDF]

				Z. M. Hijazi and S. M. Awad Pediatric Cardiac Interventions J. Am. Coll. Cardiol. Intv., December 1, 2008; 1(6): 603 - 611. [Abstract] [Full Text] [PDF]

				R. Kozlik-Feldmann, N. Lang, R. Aumann, A. Lehner, D. Rassoulian, R. Sodian, C. Schmitz, M. Hinterseer, R. Hinkel, E. Thein, et al. Patch Closure of Muscular Ventricular Septal Defects With a New Hybrid Therapy in a Pig Model J. Am. Coll. Cardiol., April 22, 2008; 51(16): 1597 - 1603. [Abstract] [Full Text] [PDF]

				C. Schreiber, J. Horer, M. Vogt, S. Fratz, M. Kunze, C. Galm, A. Eicken, and R. Lange A new treatment option for pulmonary valvar insufficiency: first experiences with implantation of a self-expanding stented valve without use of cardiopulmonary bypass Eur J Cardiothorac Surg, January 1, 2007; 31(1): 26 - 30. [Abstract] [Full Text] [PDF]

				T. Attmann, R. Quaden, T. Jahnke, S. Muller-Hulsbeck, A. Boening, J. Cremer, and G. Lutter Percutaneous Pulmonary Valve Replacement: 3-Month Evaluation of Self-Expanding Valved Stents Ann. Thorac. Surg., August 1, 2006; 82(2): 708 - 713. [Abstract] [Full Text] [PDF]