Transventricular approaches to pulmonary valve replacement

With over 100,000 Americans currently surviving with repaired tetralogy of Fallot and ever-lowering thresholds for pulmonary valve replacement, interventions on the right ventricular outflow tract will continue to drive the practice of reoperative congenital cardiac care well into the future. The natural evolution of improving surgical and transcatheter techniques is for surgical approaches to become more minimally invasive and transcatheter approaches to become bolder and more complex. Yet both interventional and surgical approaches have inherent limitations. The ability to combine these two skills with a team approach helps to minimize the limitations of each approach and maximize the patient benefit and has been described as the hybrid approach. This chapter will review the indications for a hybrid approach to pulmonary valve replacement and detail the surgical and interventional considerations, including preplanning, equipment, technique, and potential pitfalls.