The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study

Padalino, Massimo A.; Pradegan, Nicola; Azzolina, Danila; Galletti, Lorenzo; Napoleone, Carlo Pace; Agati, Salvatore; Palma, Gaetano Di; Marianeschi, Stefano; Seddio, Francesco; Cascarano, Maria Teresa; Carro, Cristina Bernis; Gregori, Darío; Vida, Vladimiro L.; Stellin, Giovanni

doi:10.1093/ejcts/ezz270

Cited by 9 publications

(18 citation statements)

References 24 publications

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“…In this cohort, 130 (45.4%) patients underwent repair without TAP augmentation, which is similar to or even better than the results reported by other centers ( 18 – 20 ). However, it is thought that the placement of the TAP often results in relatively delayed postoperative recovery after surgical repair ( 17 ).…”

Section: Discussionsupporting

confidence: 88%

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

et al. 2021

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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.

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Section: Discussionsupporting

confidence: 88%

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

et al. 2021

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“…Long-term survival after tetralogy of Fallot (TOF) repair is excellent with almost 95% of patients alive after 25 years [1], and it is mainly determined by the extent of chronic right ventricular (RV) adaptation to the post-surgical right ventricular outflow tract (RVOT) sequelae [2]. Chronic pulmonary valve (PV) regurgitation leads to RV volume overload and subsequent RV remodeling and dysfunction, associated with gradual exercise intolerance, risk of developing rhythm disturbances, and sudden death [3].…”

Section: Introductionmentioning

confidence: 99%

QRS Duration During Follow-Up of Tetralogy of Fallot: How Valuable is it? Analysis of ECG Changes in Relation to Pulmonary Valve Implantation

et al. 2021

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Long-term results after tetralogy of Fallot (TOF) repair are determined by the extent of right ventricular remodeling to chronic pulmonary regurgitation entailing progressive RV dysfunction and a risk of developing ventricular arrhythmia. Pulmonary valve replacement (PVR) can alleviate this burden. As a predictor of ventricular arrhythmia, QRS duration remains a strong parameter in this decision. We performed a retrospective analysis of all PVR patients between 2005 and 2018, studying the time evolution of electrocardiographic parameters before and after PVR through linear mixed model analysis. 42 TOF patients underwent PVR. The median timespan between primary repair and PVR was 18 years (IQR 13-30). The indication for PVR was primarily based on the association of exercise intolerance (67%) and significant RV dilation on cMRI (median RVEDVi 161 ml/m 2 IQR 133-181). Median QRS length was 155 ms (IQR 138-164), 4 (10%) patients had a QRS > 180 ms. QRS duration increased significantly before PVR, but barely showed regression after PVR. Changes of QRS duration after PVR were independent of RV dilation. In conclusion, when the decision for PVR in TOF patients is primarily based on RV volume and/or function threshold, QRS duration > 180 ms is rarely observed. In contrast with the significant increase of QRS duration before PVR, QRS length regression appears to be independent of the extent of RV dilation or QRS > 160 ms. Considering that the decision for PVR is based on mechanical RV characteristics, the utility of serial follow-up of QRS duration in contemporary operated TOF patients becomes questionable in absence of clinical arguments for ventricular arrhythmia.

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“…In a study of young adults conducted by Ducas et al in Canada, it was found that patients who received TAP surgery had a significantly higher incidence of right ventricular dilation and dysfunction and the need for reintervention at follow-up (most often pulmonary valve replacement) in long term (9) . Similarly, long-term postoperative complications, adverse events, and mortality rates were significantly higher in patients with TAP compared to patients with preserved pulmonary valve in a large multicenter study conducted by Padalino et al our study included patients who received PVSS (10) . In considering the total number of patients who underwent complete corrective repair (TAP: n= 33, PVSS: n= 30, total correction with conduit: n= 11), the PVSS rate was 40.5%, slightly higher than the results of the mentioned Italian study (10) .…”

Section: Discussionmentioning

confidence: 91%

“…Similarly, long-term postoperative complications, adverse events, and mortality rates were significantly higher in patients with TAP compared to patients with preserved pulmonary valve in a large multicenter study conducted by Padalino et al our study included patients who received PVSS (10) . In considering the total number of patients who underwent complete corrective repair (TAP: n= 33, PVSS: n= 30, total correction with conduit: n= 11), the PVSS rate was 40.5%, slightly higher than the results of the mentioned Italian study (10) . With this result, it has been evaluated that advanced international standards have been achieved in our center.…”

Section: Discussionmentioning

confidence: 91%

Pulmonary Valve-Sparing Surgery in Tetralogy of Fallot: Early Results of Pulmonary Flow Hemodynamics

Yildirim

Balaban

2020

Kosuyolu Heart Journal

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Introduction: Tetralogy of Fallot is the most common form of cyanotic congenital heart disease. We aimed to share our experience of pulmonary annulus preserving surgery as the current and increasingly preferred treatment option in this study. Patients and Methods:In this study, the data of 30 pediatric patients who underwent corrective repair by preserving the pulmonary valve annulus were evaluated retrospectively. Demographic data, angiographic, and echocardiographic findings before and after surgery were recorded. Results:In our study, 20 (66.7%) patients were male, 10 (33.3%) were female; median age of the patients was 29 months. In the preoperative evaluation, 16 patients had a pulmonary valve with two leaflets (53.3%), and 14 patients had three leaflets (46.7%). McGoon indexes calculated as mean 1.82 ± 0.23 by echocardiography and 2 ± 0.29 by angiography. Pulmonary valve annulus Z-scores were determined as mean -1.8 ± 1.1 echocardiographically and -0.9 ± 1.2 angiographically. Mean right ventricle systolic pressures measured in echocardiographic examination at 1 st , 7 th , and 14 th days after surgery were 42.3 ± 6.5, 38.7 ± 4.9, and 35.8 ± 4.9 mmHg, respectively, and decreasing values were significant statistically. Pulmonary valve pressure gradients measured at postoperative 1 st , 7 th , and 14 th days and found as mean 27.2 ± 5.6, 25.5 ± 6.2, and 24.4 ± 6.2 mmHg, respectively; this decrease was also statistically significant. There was no mortality or significant morbidity during the mean 7.97 ± 3.39 months follow-up period. Conclusion:Preservation of pulmonary valve during surgery is an effective treatment option in the treatment of tetralogy of Fallot in terms of reducing early and late complications and should become a more prevalent technique.

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The role of primary surgical repair technique on late outcomes of Tetralogy of Fallot: a multicentre study

Cited by 9 publications

References 24 publications

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

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

QRS Duration During Follow-Up of Tetralogy of Fallot: How Valuable is it? Analysis of ECG Changes in Relation to Pulmonary Valve Implantation

Pulmonary Valve-Sparing Surgery in Tetralogy of Fallot: Early Results of Pulmonary Flow Hemodynamics

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