Effect of off-pump pulmonary valvotomy as the initial surgery for pulmonary atresia with intact ventricular septum: A single-center clinical analysis_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

HE Xiaomin ,  ZHENG Jinghao , LUO Kai , SUN Qi , CHEN Huiwen , ZHU Zhongqun , XU Zhiwei , LIU Jinfen

Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai Jiaotong University School of Medicine, Shanghai, 200127, P.R.China;

Corresponding author：

ZHENG Jinghao, Email: zhengjh210@163.com

Keywords：

Pulmonary atresia with intact ventricular septum; initial surgery; pulmonary valvulotomy; hybrid therapy; off-pump

DOI：

10.7507/1007-4848.202001019

Video：

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Objective To evaluate the effect of off-pump pulmonary valvulotomy for the patients with pulmonary atresia with intact ventricular septum (PA/IVS).Methods The clinical data of 61 PA/IVS patients who underwent off-pump right ventricular decompression surgery in our hospital from January 2013 to September 2019 were retrospectively analyzed, including 37 males and 24 females, with an average age of 29.7 (2.0-86.0) d and weight of 4.1 (2.5-6.9) kg. Thirty-nine patients received off-pump pulmonary valvulotomy (an open-view valvulotomy group) and 22 patients received balloon valvuloplasty through the right ventricle pulmonary valve (a hybrid therapy group). The postoperative mortality, early re-intervention, and completion of final operation of the two groups were compared.Results There were 2 deaths in the study with a mortality rate of 3.3% (2/61), and the mortality rate of the two groups was not significantly different (2.6% vs.4.5%, P=0.68). The rate of early re-intervention in the two groups was 5.3% and 19.0%, respectively (P=0.09). There was no statistical difference in intubation time (56.0±25.9 h vs. 62.0±28.9 h, P=0.41), ICU retention time (4.7±2.9 d vs. 5.5±2.2 d, P=0.23) and postoperative hospital stay time (3.9±0.9 d vs. 4.3±1.1 d, P=0.38) between the two groups. The follow-up time was 45.3 (4.0-84.0) months. There were 5 patients lost to follow-up. During the follow-up period, in the open-view valvulotomy group, 17 patients did not need further operation, 13 patients completed the final operation. In the hybrid therapy group, 7 patients did not need further operation, 8 patients completed the final operation. Heart function classification of all patients was in New York Heart Association class Ⅰ-Ⅱ.Conclusion Compared with the hybrid therapy, off-pump pulmonary valvulotomy for PA/IVS also has the advantages of simple operation, short operation time and high survival rate, and it may be easier to be promoted in clinical application because of its more economic benefits and relatively lower re-intervention rate.

Citation： HE Xiaomin, ZHENG Jinghao, LUO Kai, SUN Qi, CHEN Huiwen, ZHU Zhongqun, XU Zhiwei, LIU Jinfen. Effect of off-pump pulmonary valvotomy as the initial surgery for pulmonary atresia with intact ventricular septum: A single-center clinical analysis. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2020, 27(4): 411-414. doi: 10.7507/1007-4848.202001019 Copy

1.	He X, Zhang X, Jing H, et al. Rare copy number variations might not be involved in the molecular pathogenesis of PA-IVS in an unselected Chinese cohort. Pediatr Cardiol, 2019, 40(4): 762-767.
2.	Yoshimura N, Yamaguchi M. Surgical strategy for pulmonary atresia with intact ventricular septum: initial management and definitive surgery. Gen Thorac Cardiovasc Surg, 2009, 57(7): 338-346.
3.	郑景浩, 徐志伟, 刘锦纷, 等. 室间隔完整型肺动脉闭锁手术治疗的个体化方案. 中华胸心血管外科杂志, 2013, 29(2): 69-72.
4.	Schneider AW, Blom NA, Bruggemans EF, et al. More than 25 years of experience in managing pulmonary atresia with intact ventricular septum. Ann Thorac Surg, 2014, 98(5): 1680-1686.
5.	Wright LK, Knight JH, Thomas AS, et al. Long-term outcomes after intervention for pulmonary atresia with intact ventricular septum. Heart, 2019, 105(13): 1007-1013.
6.	Kotani Y, Kasahara S, Fujii Y, et al. A staged decompression of right ventricle allows growth of right ventricle and subsequent biventricular repair in patients with pulmonary atresia and intact ventricular septum. Eur J Cardiothorac Surg, 2016, 50(2): 298-303.
7.	Grant S, Faraoni D, DiNardo J, et al. Predictors of mortality in children with pulmonary atresia with intact ventricular septum. Pediatr Cardiol, 2017, 38(8): 1627-1632.
8.	Chen RHS, KT Chau A, Chow PC, et al. Achieving biventricular circulation in patients with moderate hypoplastic right ventricle in pulmonary atresia intact ventricular septum after transcatheter pulmonary valve perforation. Congenit Heart Dis, 2018, 13(6): 884-891.
9.	Hascoët S, Borrhomée S, Tahhan N, et al. Transcatheter pulmonary valvuloplasty in neonates with pulmonary atresia and intact ventricular septum. Arch Cardiovasc Dis, 2019, 112(5): 323-333.
10.	Lin ZQ, Chen Q, Cao H, et al. Transthoracic balloon pulmonary valvuloplasty for treatment of congenial pulmonary atresia patients with intact ventricular septum. Med Sci Monit, 2017, 23: 4874-4879.
11.	Zampi JD, Hirsch-Romano JC, Goldstein BH, et al. Hybrid approach for pulmonary atresia with intact ventricular septum: early single center results and comparison to the standard surgical approach. Catheter Cardiovasc Interv, 2014, 83(5): 753-761.
12.	王宁, 刘大为, 刘宇航, 等. 新生儿室间隔完整型肺动脉闭锁Hybrid手术预后分析. 中国胸心血管外科临床杂志, 2018, 25(10): 910-913.
13.	Karamlou T, Poynter JA, Walters HL 3rd, et al. Long-term functional health status and exercise test variables for patients with pulmonary atresia with intact ventricular septum: A Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg, 2013, 145(4): 1018-1027.
14.	Do N, Hill KD, Wallace AS, et al. Shunt failure-risk factors and outcomes: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg, 2018, 105(3): 857-864.
15.	Sasikumar N, Hermuzi A, Fan CS, et al. Outcomes of Blalock-Taussig shunts in current era: A single center experience. Congenit Heart Dis, 2017, 12(6): 808-814.
16.	Zheng J, Gao B, Zhu Z, et al. Surgical results for pulmonary atresia with intact ventricular septum: A single-centre 15-year experience and medium-term follow-up. Eur J Cardiothorac Surg, 2016, 50(6): 1083-1088.

1. He X, Zhang X, Jing H, et al. Rare copy number variations might not be involved in the molecular pathogenesis of PA-IVS in an unselected Chinese cohort. Pediatr Cardiol, 2019, 40(4): 762-767.
2. Yoshimura N, Yamaguchi M. Surgical strategy for pulmonary atresia with intact ventricular septum: initial management and definitive surgery. Gen Thorac Cardiovasc Surg, 2009, 57(7): 338-346.
3. 郑景浩, 徐志伟, 刘锦纷, 等. 室间隔完整型肺动脉闭锁手术治疗的个体化方案. 中华胸心血管外科杂志, 2013, 29(2): 69-72.
4. Schneider AW, Blom NA, Bruggemans EF, et al. More than 25 years of experience in managing pulmonary atresia with intact ventricular septum. Ann Thorac Surg, 2014, 98(5): 1680-1686.
5. Wright LK, Knight JH, Thomas AS, et al. Long-term outcomes after intervention for pulmonary atresia with intact ventricular septum. Heart, 2019, 105(13): 1007-1013.
6. Kotani Y, Kasahara S, Fujii Y, et al. A staged decompression of right ventricle allows growth of right ventricle and subsequent biventricular repair in patients with pulmonary atresia and intact ventricular septum. Eur J Cardiothorac Surg, 2016, 50(2): 298-303.
7. Grant S, Faraoni D, DiNardo J, et al. Predictors of mortality in children with pulmonary atresia with intact ventricular septum. Pediatr Cardiol, 2017, 38(8): 1627-1632.
8. Chen RHS, KT Chau A, Chow PC, et al. Achieving biventricular circulation in patients with moderate hypoplastic right ventricle in pulmonary atresia intact ventricular septum after transcatheter pulmonary valve perforation. Congenit Heart Dis, 2018, 13(6): 884-891.
9. Hascoët S, Borrhomée S, Tahhan N, et al. Transcatheter pulmonary valvuloplasty in neonates with pulmonary atresia and intact ventricular septum. Arch Cardiovasc Dis, 2019, 112(5): 323-333.
10. Lin ZQ, Chen Q, Cao H, et al. Transthoracic balloon pulmonary valvuloplasty for treatment of congenial pulmonary atresia patients with intact ventricular septum. Med Sci Monit, 2017, 23: 4874-4879.
11. Zampi JD, Hirsch-Romano JC, Goldstein BH, et al. Hybrid approach for pulmonary atresia with intact ventricular septum: early single center results and comparison to the standard surgical approach. Catheter Cardiovasc Interv, 2014, 83(5): 753-761.
12. 王宁, 刘大为, 刘宇航, 等. 新生儿室间隔完整型肺动脉闭锁Hybrid手术预后分析. 中国胸心血管外科临床杂志, 2018, 25(10): 910-913.
13. Karamlou T, Poynter JA, Walters HL 3rd, et al. Long-term functional health status and exercise test variables for patients with pulmonary atresia with intact ventricular septum: A Congenital Heart Surgeons Society study. J Thorac Cardiovasc Surg, 2013, 145(4): 1018-1027.
14. Do N, Hill KD, Wallace AS, et al. Shunt failure-risk factors and outcomes: An analysis of the Society of Thoracic Surgeons Congenital Heart Surgery Database. Ann Thorac Surg, 2018, 105(3): 857-864.
15. Sasikumar N, Hermuzi A, Fan CS, et al. Outcomes of Blalock-Taussig shunts in current era: A single center experience. Congenit Heart Dis, 2017, 12(6): 808-814.
16. Zheng J, Gao B, Zhu Z, et al. Surgical results for pulmonary atresia with intact ventricular septum: A single-centre 15-year experience and medium-term follow-up. Eur J Cardiothorac Surg, 2016, 50(6): 1083-1088.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Effect of off-pump pulmonary valvotomy as the initial surgery for pulmonary atresia with intact ventricular septum: A single-center clinical analysis

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