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Rescue surgery following percutaneous pulmonary valve implantation

^a Cardiac Unit, Great Ormond Street Hospital for Children, NHS Trust, Great Ormond Street, WC1N 3JH London, United Kingdom
^b Policlinico San Donato Milanese IRCCS, Milan, Italy

Received 25 September 2007; received in revised form 11 December 2007; accepted 20 December 2007.

^_* Corresponding author. Tel.: +44 20 74059200; fax: +44 20 74301281. (Email: tsangv{at}gosh.nhs.uk).

Objective: Percutaneous pulmonary valve insertion (PPVI) is an evolving alternative to surgical pulmonary valve insertion. The aim of this study is to review the acute complications of PPVI requiring emergency rescue surgery. Patients and methods: Between 09/2000 and 01/2007, 152 patients (pts), received a PPVI. Patient's charts were reviewed in retrospect. Results: Emergency rescue surgery (ERS) took place in 6 pts (3.9%). Indications for ERS were: homograft rupture two pts, dislodgment of the stented valve in a dilated right ventricular outflow tract two pts, occlusion of the right pulmonary artery one pt and compression of the left main coronary artery one pt. Cardiopulmonary bypass was established through repeat sternotomy incision with femorofemoral cannulation in 2/6 pts. The stented valve was removed in five and replaced with a homograft in three and a valved conduit in two pts. One ruptured homograft was repaired leaving the stented valve in situ. All patients survived, one sustained mild neurological impairment. Conclusion: Although some of the acute complications of PPVI were probably related to a learning curve (4 among the first 50 pts and 2 among the last 102 patients) the need for ERS is unlikely to be completely abolished. This experience highlights the importance of close collaboration between cardiologists and surgeons in these evolving technologies. Highly skilled and responsive surgical back up is necessary to support the introduction and to sustain institutional programmes such as PPVI.

Key Words: Percutaneous • Pulmonary valve • Implantation • Emergency surgery