Pulmonary valve implantation using self-expanding tissue valve without cardiopulmonary bypass reduces operation time and blood product use

Objective: The study objective was to review our initial experience with newly developed off-pump pulmonary valve implantation techniques and compare outcomes with the conventional approach.

Methods: Thirteen symptomatic patients with severe pulmonary regurgitation underwent pulmonary valve implantation, 6 without cardiopulmonary bypass (group 1: age, 28 ± 21 years; range, 12-62; body surface area range, 1.38-2.39 m(2)) and 7 with cardiopulmonary bypass (group 2: age, 23 ± 13 years; range, 10-46; body surface area range, 1.31-1.89 m(2)). Ten patients had previous repair of tetralogy of Fallot, and 3 patients had pulmonary valvotomy/valvuloplasty.

Results: Mean operation times were 166 minutes (range, 110-240) in group 1 and 299 minutes (range, 221-375) in group 2 (P < .001). Hemoglobin level after chest closure was 13.4 and 9.8 g/dL in groups 1 and 2, respectively (P < .001). Postoperative chest drainage (median) was 78 and 300 mL in groups 1 and 2, respectively (P = .003). Blood product requirement was zero and 3 units (median) in groups 1 and 2, respectively (P < .014). There was no significant difference in postoperative ventilation time or lengths of intensive care unit and hospital stays between the 2 groups. Mean follow-up was 15 months; all patients are in New York Heart Association I/II. Echocardiography showed that peak velocity across the pulmonary valve was 2.2 and 2.0 in groups 1 and 2, respectively (P = .46). No patient had a paravalvular leak or more than mild pulmonary regurgitation.

Conclusions: Off-pump pulmonary valve implantation is a good alternative for pulmonary valve replacement. The procedure reduces operating time, blood loss, and blood product requirement.