Pulmonary Vein Index Is Associated With Early Prognosis of Surgical Treatment for Tetralogy of Fallot

Abstract

Objectives: To evaluate the predictive value of the pulmonary vein index (PVI) in the early prognosis of patients who received total tetralogy of Fallot (TOF) repair.Methods: We retrospectively reviewed 286 patients who underwent TOF repair in our institution between July 2013 and May 2020. The PVI, McGoon ratio, and Nakata index were measured and calculated. Logistic regression, linear stepwise regression, receiver operating characteristic (ROC) curve analysis, and Cox proportional hazards modeling were performed to evaluate the predictive value of PVI in the early prognosis after TOF repair surgery.Results: The median age and body weight were 1.23 (0.22–15.02) years and 9.00 (3.00–44.00) kg, respectively. There were five early deaths. The areas under the ROC curve for death were 0.89, 0.79, and 0.88 for the McGoon ratio, Nakata index, and PVI, respectively. A lower PVI better predicted prolonged postoperative hospital stay, cardiac intensive care unit stay, and ventilator time (Hazard Ratio, HR [95% Confidence intervals, CI]: 1.003 [1.002–1.004], p < 0.001; 1.002 [1.001–1.004], p < 0.001; 1.002 [1.001–1.003], p < 0.001, respectively) and was a significant risk factor for high 24 h max Vasoactive inotropic score (Crude Odds Ratio [OR] [95% CI]: −0.015 [−0.022, −0.007], p < 0.001), serous effusion (Crude OR [95% CI]: 0.996 [0.992–0.999], p = 0.020), delayed sternal closure (Crude OR [95% CI]: 0.983 [0.971–0.996], p = 0.010), and the need for peritoneal dialysis (Crude OR [95% CI]: 0.988 [0.980–0.996], p = 0.005). The area under the ROC curve of PVI for delayed postoperative recovery was 0.722 (p < 0.001), and the estimated cutoff point was 300.3 mm2/m2.Conclusion: PVI is a good predictor of early prognosis for surgical treatment of TOF patients.

Higher pulmonary vein index on computed angiography and optimum surgical resection ensures smooth postoperative recovery in Fallot's tetralogy: Special emphasis on indices of evaluation and Monocusp preparation

“…In their study, Yuan et al indicated that a reduced PVI is a significant risk factor for early death and prolonged postoperative recovery. They estimated the cutoff point of PVI at 300.3 mm 2 /m 2 12 . In our case, the PVI was 368.12 mm 2 /m 2 , which resulted in an uneventful postoperative recovery.…”

“…In this study, we evaluated the predictive value of PVI for the determination of early postoperative outcomes among patients with TOF. A reduced PVI is a significant risk factor for both early mortality and prolonged postoperative recovery 12 …”

“…Pulmonary blood flow has a major effect on the prognosis of patients with CHDs, and PA parameters, such as the McGoon ratio and Nakata index, are the most commonly used parameters to evaluate pulmonary blood flow and are also frequently used as prognostic indicators for the successful surgical repair of TOF. 10,12 However, it has been shown that the PVI provides a more accurate indicator of pulmonary blood flow than that of the PAs. 10 Another objective of this case report was to assess the performance of PTFE-MVs.…”

“…This provides the most accurate CSA, especially in cases of an oval or elongated lumen (Figure 2D). The PVI is calculated using the following formula 12 :…”

“…A previous study by Yuan et al 12 evaluated the predictive abilities of the PVI for the early outcomes of TOF repair. They concluded that cardiac CT scans provide the fastest means of gathering the relevant measures compared with echocardiography and magnetic resonance angiography and provide better spatial resolution.…”