Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus

Hoashi, Takaya; Kagisaki, Koji; Yin, Min-Jean; Sakaguchi, Heima; Kurosaki, Kenichi; Shiraishi, Isao; Yagihara, Toshikatsu; Ichikawa, Hajime

doi:10.1016/j.jtcvs.2014.06.008

Cited by 45 publications

(40 citation statements)

References 23 publications

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“…Pulmonary valve z-score 4 or less was found to be a predictor of recurrent RVOT obstruction in other series [ 13 ] and our current strategy is to preserve the pulmonary valve in patients without severe annular hypoplasia. Hoashi et al, [ 14 ] found that pulmonary valve z-score was not a predictor of recurrent ROVT obstruction but z-score less than − 2 was a predictor of progressive pulmonary regurgitation which was not found in our study, the degree of pulmonary regurgitation regressed by one grade in 10 patients during the follow up. The most common pulmonary valve morphology encountered was a bicuspid valve followed by tricuspid morphology.…”

Section: Discussioncontrasting

confidence: 85%

Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair

Arafat

Elatafy

Elshedoudy

et al. 2018

J Cardiothorac Surg

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BackgroundRight ventricular (RV) volume overload increases morbidity and mortality after tetralogy of Fallot (TOF) repair. Surgical strategies like pulmonary leaflets sparing and tricuspid valve repair at time of primary repair may decrease RV overload. Our objective is to evaluate early and midterm results of pulmonary leaflets sparing with infundibular preservation and tricuspid valve repair in selected TOF patients with moderate pulmonary annular hypoplasia.MethodsFrom 2011 to 2016; 46 patients with TOF and moderate pulmonary annular hypoplasia had surgical repair with sparing of the pulmonary valve leaflets. Concomitant tricuspid valve repair was performed in 33 patients (71.8%). Mean age was 13.1 ± 4.8 months, 68% were males (n = 31) and mean weight was 9.5 ± 2.3 kg. Preoperative McGoon ratio was 1.9 ± 0.4 and pulmonary valve z-score ranges from − 2 to − 3. Preoperative pressure gradient of RVOT was 80.9 ± 7.7 mmHg and 10.9% had minor coronary anomalies (n = 5).ResultsAll repairs were performed through trans-atrial trans-pulmonary approach. 87% had pulmonary valve commissurotomy (n = 40). Mean cardiopulmonary bypass time was 71 ± 6.3 min and ischemic time 42.4 ± 4.9 min. Hospital mortality occurred in 4.3% (n = 2). Mean RVOT pressure gradient decreased significantly postoperatively (28.8 ± 7.2 mmHg, p-value< .001) and at the last follow up (23.6 ± 1.8 mmHg, p-value< .001). Pulmonary regurgitation progressed by one grade in 2 patients compared to the postoperative grade. 1 patient (2.5%) had late mortality and reintervention was required in 5 patients (12.5%).ConclusionPulmonary leaflets sparing, and tricuspid valve repair are safe for TOF repair with no added morbidity or mortality. These procedures could contribute to reducing right ventricular volume overload over time after TOF repair.

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Section: Discussioncontrasting

confidence: 85%

Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair

Arafat

Elatafy

Elshedoudy

et al. 2018

J Cardiothorac Surg

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“…They reported that aggressive right ventricle outflow tract muscle resection contributed to the prevention of recurrent right ventricle outflow tract obstruction, even though patients had a pressure ratio (right ventricle/aorta) >0.7 and a small pulmonary valve annulus. 9 Similarly, we admitted the concern about subvalvar stenosis on echocardiogram in operating room, but we could not suggest any cut-off pressure ratio in operating room from our study. There are limitations in evaluating pressure gradient or right ventricular pressure in operating room.…”

Section: Discussionmentioning

confidence: 57%

The progression of an acceptable pulmonary stenosis immediately after total correction of tetralogy of Fallot

et al. 2020

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Background:A certain degree of pulmonary stenosis after total correction of tetralogy of Fallot has been considered acceptable. But the long-term outcomes are not well understood. We observed the natural course of immediate pulmonary stenosis and investigated related factors for progression.Methods:Fifty-two patients with acceptable pulmonary stenosis immediately after operation were enrolled. Acceptable pulmonary stenosis was defined as peak pressure gradient between 15 and 45 mmHg by Doppler echocardiography. Latent class linear mixed model was used to differentiate patients with progressed pulmonary stenosis, and the factors related to progression were analysed.Results:Pulmonary stenosis progressed in 14 patients (27%). Between the progression group and no progression group, there were no significant differences in operative age, sex, and the use of the transannular patch technique. However, immediate gradient was higher in the progression group (32.1 mmHg versus 25.7 mmHg, p = 0.009), and the cut-off value was 26.8 mmHg (sensitivity = 65.3%, specificity = 65.8%). Main stenosis at the sub-valve was observed more frequently in the progression group (85.7% versus 52.6%, p = 0.027). Despite no difference in the preoperative pulmonary valve z value, the last follow-up pulmonary valve z value was significantly lower in the progression group (−1.15 versus 0.35, p = 0.002).Conclusions:Pulmonary stenosis immediately after tetralogy of Fallot total correction might progress in patients with immediate pulmonary stenosis higher than ≥26.8 mmHg and the main site was sub-valve area.

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“…8 Twenty-year data are emerging for a valve-sparing approach, with encouraging freedom from ventricular arrhythmia, but era differences make comparison difficult. 9 The Rotterdam data strengthen evidence that TAP is a factor predicting late dysfunction, arrhythmia, or death, which finds support in some but not all series.…”

Section: At the Front Endmentioning

confidence: 80%

Fourth Decade After Repair of Tetralogy of Fallot

Bichell

2014

Circulation

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Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus

Cited by 45 publications

References 23 publications

Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair

Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair

The progression of an acceptable pulmonary stenosis immediately after total correction of tetralogy of Fallot

Fourth Decade After Repair of Tetralogy of Fallot

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