Beating heart replacement of the pulmonary valve using stented bioprosthesis in patients with surgical corrected Tetralogy of Fallot

  • Dr Fotios Mitropoulos, Department of Pediatric and Congenital heart surgery, Onassis Cardiac Surgery Center, Athens, Greece, Greece
  • Dr Meletios Kanakis, Department of Pediatric and Congenital heart surgery, Onassis Cardiac Surgery Center, Athens, Greece, Greece
  • Dr Nicholaos Giannopoulos, Department of Pediatric and Congenital heart surgery, Onassis Cardiac Surgery Center, Athens, Greece, Greece
  • Dr Constantinos Contrafouris, Department of Pediatric and Congenital heart surgery, Onassis Cardiac Surgery Center, Athens, Greece, Greece
  • Dr Andreas Chatzis, Department of Pediatric and Congenital heart surgery, Onassis Cardiac Surgery Center, Athens, Greece, Greece
  • Dr Michael Mylonakis, Department of Pediatric and Congenital heart surgery, Onassis Cardiac Surgery Center, Athens, Greece, Greece
  • Dr Prodromos Azariades, Department of Pediatric and Congenital heart surgery, Onassis Cardiac Surgery Center, Athens, Greece, Greece

    • Objective We present our early results of pulmonary valve PV replacement with the beating heart technique using oversized bioprosthetic valves in patients with surgical corrected Tetralogy of Fallot (SCTOF).
    Patients-Methods From September 2005 to December 2008, 35 patients (aged from 9 years to 56 years, old 24 males and 11 females) with SCTOF underwent PV replacement after a period ranged from 4 to 35 years from the anatomic correction. Our choice of prosthesis was the stented bioprosthetic Aortic Magna (Edwards, Lifesciences) valve. Thirty two valves were size 27mm, two 25mm and one 23mm. The operation was performed with the beating heart technique under normothermic extracorporeal circulation. Concomitant surgical procedures included tricuspid valve annuloplasty (n =22), resection of aneurysmal outflow tract patches (n=18), augmentation of stenotic pulmonary arteries (n=8) and right ventricular remodeling (n=9).
    Results There was one perioperative death (2.8%) and one patient (2.8%) developed atrial flutter. Mean hospital stay was 9 days. Cardiac echocardiography during the latest follow-up (from 6 months to 38 months after the operation) revealed bioprosthesis without significant stenosis or regurgitation (n=34). Significant decrease of the right heart dimensions was also observed (n=34). 32 patients are in NYHA I and 2 patients are in NYHA I-II, up to day.
    Conclusions The use of the new bioprosthetic valves using the beating heart technique provide excellent immediate and short-term outcome. Further follow-up is necessary to evaluate the durability of this valve in the pulmonary position.