Pulmonary reinterventions after complete unifocalization and repair in infants and young children with tetralogy of Fallot with major aortopulmonary collaterals

Bauser‐Heaton, Holly; Borquez, Alejandro A.; Asija, Ritu; Wise‐Faberowski, Lisa; Zhang, Yulin; Downey, Laura; Perry, Stanton B.; Koth, Andrew; Peng, Lynn F.; Algaze, Claudia; Hanley, Frank L.; McElhinney, Doff B.

doi:10.1016/j.jtcvs.2017.11.086

Cited by 25 publications

(16 citation statements)

References 29 publications

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“…However, we found that relatively few follow-up LPS studies had been entered in our database, so we removed the follow-up evaluation from the study, recognizing that the available data would not necessarily represent the overall cohort. We recently analyzed our experience with reinterventions after complete repair, 25 although LPS data were not reported in that study. We are currently working to obtain and add to the database more complete follow-up LPS data to undertake analyses of serial LPS findings as a separate study.…”

Section: Commentmentioning

confidence: 99%

Assessment of the Reconstructed Pulmonary Circulation With Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals

Wise‐Faberowski

Irvin

Lennig

et al. 2019

World J Pediatr Congenit Heart Surg

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Background: Pulmonary vascular supply in tetralogy of Fallot (TOF) with major aortopulmonary collaterals (MAPCAs) is highly variable. Our approach to surgical management of this condition emphasizes early repair including unifocalization and reconstruction of the pulmonary circulation, incorporating all lung segments and addressing stenoses both proximal to and within the lung, in addition to ventricular septal defect closure. At our institution, we have over 15 years of experience using lung perfusion scintigraphy (LPS) to assess the distribution of pulmonary blood flow after complete unifocalization and repair. Methods: We reviewed clinical and quantitative LPS data in 310 patients who underwent complete unifocalization and repair of TOF/MAPCAs from 2003 to 2018 at our institution. Postrepair relative lung perfusion distributions were determined from LPS initially obtained at our institution within 60 days after repair and thereafter. Results: Total lung perfusion to the right and left lungs was 58.0% + 14.2% and 42.0% + 14.2%, respectively. Perfusion was balanced in 75% of patients and unbalanced in 25%, including 11% in whom it was extremely unbalanced. On multivariable analysis, older age at repair, surgery other than a single-stage complete unifocalization, and native anatomy consisting of unilateral pulmonary blood supply through a ductus arteriosus were associated with unbalanced perfusion. Conclusion: We present our experience using LPS as an outcome measure after surgical repair of TOF/ MAPCAs. Balanced lung perfusion was present in the majority of patients who had complete repair of TOF/MAPCAs performed at our center.

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Section: Commentmentioning

confidence: 99%

Assessment of the Reconstructed Pulmonary Circulation With Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals

Wise‐Faberowski

Irvin

Lennig

et al. 2019

World J Pediatr Congenit Heart Surg

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“…Carotti et al [13] reported a 52% freedom-from-percutaneous intervention rate after 14 years of unifocalization. Freedom from any Pa reintervention was 64% at five years in the Stanford group [20] . Pa reinterventions are crucial to maintain the right ventricular pressure as low as possible.…”

Section: Resultsmentioning

confidence: 86%

Surgical Strategies and Results for Repair of Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals: Experience of a Single Tertiary Center

Haydın

Genç

Yıldız

et al. 2020

Braz J Cardiovasc Surg

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Objective: To evaluate surgical management and results of patients with pulmonary atresia and ventricular septal defect with major aortopulmonary collateral arteries (PA/VSD/MAPCAs). Methods: We reviewed a consecutive series of patients with PA/VSD/MAPCAs between January 2012 and October 2018. Study patients were separated into Group A, efficient MAPCAs; Group B, hypoplastic MAPCAs; Group C, severe hypoplastic MAPCAs at all divisions; and Group D, distal stenosis at most MAPCAs divisions. Results: Thirty-six patients were included in the study. Median age at operation time was 5.5 months (2-110 months), median weight was 8 kg (2.5-21 kg), and median number of MAPCAs was three (1-6). In Group A, 14 patients underwent singlestage total correction (TC); in Group B, 18 patients underwent unifocalization and central shunting; and in Group C, four patients had aortopulmonary window creation and collateral ligation. No patient was placed in Group D. Seventy percent of patients (n=25) had the TC operation. Early mortality was not seen in Group A, but the other two groups had a 13.6% mortality rate. At the follow-up, three patients had reintervention, two had new conduit replacement, and one had right ventricular outflow tract reconstruction. Conclusion: Evaluating patients with PA/VSD/MAPCAs in detail and subdividing them is quite useful in determining the appropriate surgical approach. With this strategy, TC can be achieved in most patients. Single-stage TC is better than other surgical methods due to its lower mortality and reintervention rates. Care should be taken in terms of early postoperative intensive care complications and reintervention indications during follow-ups.

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“…However, using PA reintervention as an outcome metric in this population is not ideal, as PA reinterventions are performed for a variety of circumstances in our population and do not necessarily indicate important residual or recurrent disease. 24 Thus, the burden of transcatheter reintervention in this cohort may be overestimated, insensitive to analysis of predisposing factors, and independent of flow study results.…”

Section: Commentmentioning

confidence: 79%

Mid-Term Outcomes After Unifocalization Guided by Intraoperative Pulmonary Flow Study

Goodman

Zhang

et al. 2021

World J Pediatr Congenit Heart Surg

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Background: Repair of tetralogy of Fallot (TOF) with major aortopulmonary collateral arteries (MAPCAs) requires unifocalization of pulmonary circulation, intracardiac repair with the closure of the ventricular septal defect, and placement of a right ventricle (RV) to pulmonary artery (PA) conduit. The decision to perform complete repair is sometimes aided by an intraoperative flow study to estimate the total resistance of the reconstructed pulmonary circulation. Methods: We reviewed patients who underwent unifocalization and PA reconstruction for TOF/MAPCAs to evaluate acute and mid-term outcomes after repair with and without flow studies and to characterize the relationship between PA pressure during the flow study and postrepair RV pressure. Results: Among 579 patients who underwent unifocalization and PA reconstruction for TOF/MAPCAs, 99 (17%) had an intraoperative flow study during one (n = 91) or more (n = 8) operations to determine the suitability for a complete repair. There was a reasonably good correlation between mean PA pressure at 3 L/min/m2 during the flow study and postrepair RV pressure and RV:aortic pressure ratio. Acute and mid-term outcomes (median: 3.8 years) after complete repair in the flow study patients (n = 78) did not differ significantly from those in whom the flow study was not performed (n = 444). Furthermore, prior failed flow study was not associated with differences in outcome after subsequent intracardiac repair. Conclusions: The intraoperative flow study remains a useful adjunct for determining the suitability for complete repair in a subset of patients undergoing surgery for TOF/MAPCAs, as it is reasonably accurate for estimating postoperative PA pressure and serves as a reliable guide for the feasibility of single-stage complete repair.

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Pulmonary reinterventions after complete unifocalization and repair in infants and young children with tetralogy of Fallot with major aortopulmonary collaterals

Cited by 25 publications

References 29 publications

Assessment of the Reconstructed Pulmonary Circulation With Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals

Assessment of the Reconstructed Pulmonary Circulation With Lung Perfusion Scintigraphy After Unifocalization and Repair of Tetralogy of Fallot With Major Aortopulmonary Collaterals

Surgical Strategies and Results for Repair of Pulmonary Atresia with Ventricular Septal Defect and Major Aortopulmonary Collaterals: Experience of a Single Tertiary Center

Mid-Term Outcomes After Unifocalization Guided by Intraoperative Pulmonary Flow Study

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