Preserving the pulmonary valve during early repair of tetralogy of Fallot: Anatomic substrates and surgical strategies

Vida, Vladimiro L.; Angelini, Annalisa; Guariento, Alvise; Frescura, Carla; Fedrigo, M.; Padalino, Massimo A.; Sanders, Stephen P.; Thiene, Gaetano; Stellin, Giovanni

doi:10.1016/j.jtcvs.2015.01.030

Cited by 45 publications

(59 citation statements)

References 25 publications

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“…Recently, there has been a growing enthusiasm for TOF repair techniques that involve preserving the PV and annulus, even at the expense of moderate residual stenosis [11][12][13]. Meticulous valvuloplasty has lead to valve preservation in more than 50% in other series [12]. Whether valve preservation translates into late clinical advantages is difficult to prove.…”

Section: Commentmentioning

confidence: 99%

Annulus-Sparing Tetralogy of Fallot Repair: Low Risk and Benefits to Right Ventricular Geometry

Hickey

Pham-Hung

Halvorsen

et al. 2018

The Annals of Thoracic Surgery

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Pursuit of annulus-sparing repair strategies can lower the use of transannular patch to approximately 30% with low risk of reoperation for the patient. Annulus-sparing repair is associated with significantly reduced long-term RV dilation. Pulmonary valve enlargement to approximately 10 mm and right ventricular systolic pressure less than 50 mm Hg during annulus-sparing repair are associated with low risk of recurrent stenosis.

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Section: Commentmentioning

confidence: 99%

Annulus-Sparing Tetralogy of Fallot Repair: Low Risk and Benefits to Right Ventricular Geometry

Hickey

Pham-Hung

Halvorsen

et al. 2018

The Annals of Thoracic Surgery

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“…Indeed, it is not a technique that has been widely adopted. 6,7 The study of Hofferberth and colleagues 5 shows that in a substantial number of patients, IBD does not protect either from the development of pulmonary regurgitation (PR) or from the need for subsequent PV reinterventions. Despite a shorter follow-up time, the IBD group had a higher incidence of PV reinterventions compared to the matched cohort of patients who underwent transannular patch (TAP) placement.…”

Section: Emile Bacha MDmentioning

confidence: 99%

A functional pulmonary valve after tetralogy of Fallot repair: A fool's errand?

Bacha

2018

The Journal of Thoracic and Cardiovascular Surgery

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“…We commend the Padova group for their innovative technical approaches to valve-sparing tetralogy of Fallot (ToF) repair. [1][2][3] Over the past decade, several valve-sparing techniques have been reported, but comprehensive long-term follow-up data have been lacking. As a consequence, valid assessment and comparison of surgical approaches remains a significant challenge.…”

Section: Valve-sparing Repair In Tetralogy Of Fallot: Does Valve Biolmentioning

confidence: 99%

Intraoperative balloon dilation in tetralogy of Fallot: Is there a “secret sauce”?

Bacha

2018

The Journal of Thoracic and Cardiovascular Surgery

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and Stellin are to be congratulated for doggedly pursuing techniques that render pediatric cardiac surgery less morbid. One of the areas they are known for is the use of intraoperative balloon dilation in tetralogy of Fallot surgery. In their hands, intraoperative balloon dilation is only 1 step within a comprehensive management of the pulmonary valve during tetralogy of Fallot repair. 1 They have championed the use of more complex plasty maneuvers, including surgical delamination of hypoplastic or dysplastic leaflets, as well as patch reconstruction of damaged leaflets. Our unit has had a similar approach, using the same calibration of balloons they describe, aiming for an increase of the pulmonary annulus (after commissurotomy and balloon dilation) of 2 to 3 mm. However, our own results, specifically regarding long-term avoidance of reinterventions, have not been as good as the results reported in this letter. Although I agree with the criticism that the choice of balloon size may have been too aggressive in Boston, resulting in a 20% rate of leaflet tears, 2 I don't agree with this letter's conclusion, which is that their results are superior simply because they size their balloons differently and perform different (or more aggressive) leaflet pasty maneuvers. The study by Hofferberth and colleagues 2 is a matched cohort analysis of 162 patients, a statistically speaking superior design, whereas the data from Padua are purely historical/retrospective data, which render biases such as hindsight bias almost impossible to eliminate. One may also ask why this technique has not been adopted widely. As far as published data, only Boston, Padua, and New York 3 are on the map. It may be time to actively engage other centers, debate the technique in an open forum, and try to move the field forward.

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Preserving the pulmonary valve during early repair of tetralogy of Fallot: Anatomic substrates and surgical strategies

Cited by 45 publications

References 25 publications

Annulus-Sparing Tetralogy of Fallot Repair: Low Risk and Benefits to Right Ventricular Geometry

Annulus-Sparing Tetralogy of Fallot Repair: Low Risk and Benefits to Right Ventricular Geometry

A functional pulmonary valve after tetralogy of Fallot repair: A fool's errand?

Intraoperative balloon dilation in tetralogy of Fallot: Is there a “secret sauce”?

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