Comparison Of Median Sternotomy And Left Anterior Mini-incision For Pulmonary Valve Replacement Following Tetralogy Of Fallot Repair
Cathlyn K. Medina, BA, Steven W. Thornton, MD, Lillian Kang, MD, Joseph Nellis, MD, John Haney, MD, Douglas M. Overbey, MD, MPH, Joseph W. Turek, MD, MBA, PhD.
Duke University, Durham, NC, USA.
Objective(s): Pulmonary valve insufficiency occurs frequently after primary tetralogy of Fallot (ToF) repair, due to transannular patch technique or valvular degeneration. These patients often require repeat pulmonary valve replacements (PVR) throughout their lifetime. This study compares our preferred technique of minimally invasive 5cm left anterior mini-incision (LAMI) with redo median sternotomy for PVR in ToF patients.
Methods: This a single-center, retrospective review of patients with ToF who underwent PVR via LAMI or redo median sternotomy between 4 February, 2015-14 December, 2022. Outcomes were compared.
Results: In total, thirty-two patients underwent PVR following primary ToF repair between February 2015-December 2022 (Table 1). Sixteen patients underwent redo median sternotomy from February 2015-August 2018. LAMI was first offered in August of 2018 and was chosen by all remaining patients thereafter. The two cohorts had similar baseline characteristics including preoperative pulmonary valve dysfunction. Patients undergoing LAMI had longer operative and cardiopulmonary bypass times compared to those with redo sternotomy, consistent with other minimally invasive techniques. Other outcomes were comparable including blood product utilization, postoperative pain scores, residual pulmonary valve dysfunction, ICU length of stay (LOS), and hospital LOS. Neither group had any postoperative complications.
Conclusions: In patients who have undergone primary ToF repairs, outcomes for PVR via LAMI are comparable to those via redo median sternotomy, with the added advantage of avoiding sternal precautions at time of discharge.
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