{"title":"Comparative Outcomes of Left Anterior Thoracotomy Versus Resternotomy for Pulmonic Valve Replacement After Tetralogy of Fallot Repair.","authors":"Noppon Taksaudom, Amarit Phothikun, Jakaparn Horsatidkul, Thitipong Thepsuwan, Surin Woragidpoonpol","doi":"10.1177/15569845261477377","DOIUrl":null,"url":null,"abstract":"<p><strong>Objective: </strong>Redo pulmonary valve replacement (PVR) in patients with prior tetralogy of Fallot (TOF) repair is surgically challenging. This study aimed to compare the clinical outcomes of the left anterior minithoracotomy (LAT) approach with the traditional resternotomy approach for PVR.</p><p><strong>Methods: </strong>A retrospective analysis was conducted on 38 TOF patients who underwent redo PVR, categorized into LAT (<i>n</i> = 20) and resternotomy (<i>n</i> = 18) groups. Patients requiring concomitant valvular surgeries or repair of residual intracardiac shunts were excluded. We compared demographics, operative details, and postoperative outcomes.</p><p><strong>Results: </strong>Baseline demographics were comparable between groups, except for a higher proportion of males in the LAT group (75% vs 38.9%, <i>P</i> = 0.047). The LAT approach demonstrated nonsignificant favorable trends, including shorter operative times (157.05 ± 49.42 vs 178.06 ± 58.69 min, <i>P</i> = 0.239) and shorter postoperative hospital stays (4.75 ± 1.21 vs 6.17 ± 4.38 days, <i>P</i> = 0.173). Vasoactive-inotropic scores were significantly lower in the LAT group both immediately postoperatively (0.05 ± 0.22 vs 4.36 ± 6.95, <i>P</i> = 0.009) and on postoperative day 1 (0 vs 2.17 ± 4.52, <i>P</i> = 0.039). Postoperative complications, such as atrial fibrillation and pleural effusion, were similar between groups. There was no mortality in either group.</p><p><strong>Conclusions: </strong>The LAT approach for PVR after TOF repair is a safe alternative to resternotomy. Comprehensive preoperative imaging evaluation is crucial for determining the optimal incision site. Further studies with larger cohorts are needed to confirm the potential benefits of this approach.</p>","PeriodicalId":13574,"journal":{"name":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","volume":" ","pages":"15569845261477377"},"PeriodicalIF":1.7000,"publicationDate":"2026-10-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery","FirstCategoryId":"1085","ListUrlMain":"https://doi.org/10.1177/15569845261477377","RegionNum":0,"RegionCategory":null,"ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"SURGERY","Score":null,"Total":0}
引用次数: 0
Abstract
Objective: Redo pulmonary valve replacement (PVR) in patients with prior tetralogy of Fallot (TOF) repair is surgically challenging. This study aimed to compare the clinical outcomes of the left anterior minithoracotomy (LAT) approach with the traditional resternotomy approach for PVR.
Methods: A retrospective analysis was conducted on 38 TOF patients who underwent redo PVR, categorized into LAT (n = 20) and resternotomy (n = 18) groups. Patients requiring concomitant valvular surgeries or repair of residual intracardiac shunts were excluded. We compared demographics, operative details, and postoperative outcomes.
Results: Baseline demographics were comparable between groups, except for a higher proportion of males in the LAT group (75% vs 38.9%, P = 0.047). The LAT approach demonstrated nonsignificant favorable trends, including shorter operative times (157.05 ± 49.42 vs 178.06 ± 58.69 min, P = 0.239) and shorter postoperative hospital stays (4.75 ± 1.21 vs 6.17 ± 4.38 days, P = 0.173). Vasoactive-inotropic scores were significantly lower in the LAT group both immediately postoperatively (0.05 ± 0.22 vs 4.36 ± 6.95, P = 0.009) and on postoperative day 1 (0 vs 2.17 ± 4.52, P = 0.039). Postoperative complications, such as atrial fibrillation and pleural effusion, were similar between groups. There was no mortality in either group.
Conclusions: The LAT approach for PVR after TOF repair is a safe alternative to resternotomy. Comprehensive preoperative imaging evaluation is crucial for determining the optimal incision site. Further studies with larger cohorts are needed to confirm the potential benefits of this approach.
目的：重做肺动脉瓣置换术（PVR）对先前法洛四联症（TOF）患者的修复具有外科挑战性。本研究旨在比较左前小胸切开术（LAT）入路与传统胸骨切开术治疗PVR的临床结果。方法：回顾性分析38例行重做PVR的TOF患者，分为LAT组（n = 20）和胸骨切开术组（n = 18）。排除了需要同时进行瓣膜手术或修复残余心内分流的患者。我们比较了人口统计学、手术细节和术后结果。结果：除了LAT组男性比例较高（75% vs 38.9%, P = 0.047）外，各组间基线人口统计学具有可比性。LAT入路手术时间（157.05±49.42 vs 178.06±58.69 min, P = 0.239）和住院时间（4.75±1.21 vs 6.17±4.38 d, P = 0.173）均无明显优势。LAT组的血管活性-肌力评分在术后即刻（0.05±0.22 vs 4.36±6.95,P = 0.009）和术后第1天（0 vs 2.17±4.52,P = 0.039）均显著降低。术后并发症，如心房颤动和胸腔积液，组间相似。两组均无死亡病例。结论：在TOF修复后，LAT入路治疗PVR是一种安全的选择。术前综合影像学评估是确定最佳切口位置的关键。需要更大规模的进一步研究来证实这种方法的潜在益处。
期刊介绍：
Innovations: Technology and Techniques in Cardiothoracic and Vascular Surgery is the first journal whose main mission is to disseminate information specifically about advances in technology and techniques that lead to less invasive treatment of cardiothoracic and vascular disease. It delivers cutting edge original research, reviews, essays, case reports, and editorials from the pioneers and experts in the field of minimally invasive cardiothoracic and vascular disease, including biomedical engineers. Also included are papers presented at the annual ISMICS meeting. Official Journal of the International Society for Minimally Invasive Cardiothoracic Surgery
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