Late management of the aortic root after repair of tetralogy of Fallot: A European multicentre study

Abstract

Objectives: We sought to determine the indications, type, and outcomes of reoperations on the aortic root after repair of tetralogy of Fallot (TOF). Methods: Eleven centers belonging to the European Congenital Heart SurgeonsAssociation contributed to the data collection process. We included 36 patients who underwent surgical procedures on the aortic root, including surgery on the aortic valve and ascending aorta, between January 1975 and December 2017. Original diagnoses included TOF-pulmonary stenosis (n = 18) and TOF-pulmonary atresia (n = 18). The main indications for reoperation were aortic insufficiency (n = 19, 53%), aortic insufficiency and dilatation of the ascending aorta (n = 10, 28%), aortic root dilatation (n = 4, 11%), and ascending aorta dilatation (n = 3, 8%). Results:The median age at reoperation was 30.4 years (interquartile range 20.3-45.3 years), and mechanical aortic valve replacement was the most common procedure performed. Five patients died early after reoperation (14%), and larger ascending aorta diameters were associated with early mortality (P = .04). The median age at the last follow-up was 41.4 years (interquartile range 24.5-51.6 years). Late death

Increased Aortic Stiffness and Left Ventricular Dysfunction Exist After Truncus Arteriosus Repair

“…Recent follow-up data in tetralogy of Fallot patients have identified that 29% of patients require aortic reoperations for: aortic insufficiency (53%), aortic insufficiency and ascending aortic dilation (28%), aortic root dilation (11%), and isolated ascending aortic dilation (8%). 22 The presented cohort of patients demonstrated increased ascending aortic stiffness despite normal aortic size, suggesting that elevated stiffness results from abnormal flow patterning and resultant nonuniform flowmediated shear forces. Although the present study demonstrates 2-dimensional PC-MRI data, our group has also demonstrated that supra-physiologic helical flow patterns exist in the ascending aorta of patients after tetralogy of Fallot repair by 4-dimensional flow MRI and have demonstrated an association with abnormal systolic outflow patterns within the left ventricle.…”

The Surgical Strategy for Progressive Dilatation of Aortic Root and Aortic Regurgitation After Repaired Tetralogy of Fallot: A Case Report

“…Commonly, surgical intervention is the primary option when the diagnosis of aortic complications after rTOF is confirmed. Whereas the risks for both postoperative complications and early mortality are significantly higher, therefore, preoperative assessment should be emphasized ( 11 ). Currently, the recommended threshold of ascending aorta for surgical intervention is set as 55 mm ( 12 ).…”

Proximal Aortic Dilatation and Pulmonary Valve Replacement in Patients with Repaired Tetralogy of Fallot: Is There a Relationship? A Cardiac Magnetic Resonance Imaging Study

“…There was no early or late mortality after aortic surgical reintervention in our patients. However, a multicenter retrospective study that investigated the outcomes of late surgical management of aortopathy in 36 patients with rTOF reported high risk of early (14%) and late (16%) operative mortality, which was associated with larger aortic diameters [6]. This emphasizes the importance of addressing aortopathy during the planning of any future surgical reintervention, especially with PVR, which represents about one-third of re-interventions and was correlated with proximal aortic dilatation.…”

“…Some of these factors include the rate of progression of aortic dilatation; the severity of AR; the number of prior cardiac surgical procedures, which may increase the risk of further surgery; and the presence of family history of TAD or genetic mutation, which can accelerate the rate of aortic dilatation and dissection. Some studies have shown that both emergent [5] and elective [6] proximal aortic and/or aortic valve surgeries in patients with rTOF carry a high risk of operative mortality. Hence, addressing proximal aortic dilatation and AR in the same session as PVR may be logical.…”

“…Despite the progressive nature of aortopathy, thoracic aortic dissection (TAD) is rarely reported [5]. However, the need for aortic valve surgery due to progressive aortic valve regurgitation (AR) is not uncommon [6]. Aortopathy is gaining increasing interest, but, unfortunately, clear data on the definition of aortic dilatation, the associated factors and predictors of aortic dilatation, and subsequent complications are lacking.…”