Valve-Sparing Tetralogy of Fallot Repair With Intraoperative Dilation of the Pulmonary Valve. Mid-Term Results

Lozano-Balseiro, María; García-Vieites, María; Martínez-Bendayán, Isaac; García-Hernández, Irene; Cuenca-Castillo, José J.; Rueda-Núñez, Fernando; Bautista-Hernández, Víctor

doi:10.1053/j.semtcvs.2019.04.007

Cited by 15 publications

(16 citation statements)

References 17 publications

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“…Although the highest benefit will be obtained when applied to patients with moderate pulmonary stenosis or dysplasia, it has been observed in the follow-up of the more hypoplastic valves that the growth of the valve is similar to the traditional methods, and the rate of pulmonary insufficiency is higher. Lozano-Balseiro et al in their recent study had reported that positive results were obtained in early and midterm pulmonary stenosis with balloon valvuloplasty, but progressive pulmonary insufficiency may occur in the long term (11) . Similar progressive pulmonary insufficiency after balloon valvuloplasty was reported in the study conducted by Hofferberth et al, and it was emphasized that right ventricular dilation midterm results were similar to TAP.…”

Section: Discussionmentioning

confidence: 98%

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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Section: Discussionmentioning

confidence: 98%

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

Yildirim

Balaban

2020

Kosuyolu Heart Journal

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“…18 Literature has shown a clear advantage of PV repair strategy of RVOT repair in TOF with much fewer postoperative hours of mechanical ventilation, shorter ICU & hospital stay and operative mortality. 19 Technically it saves lot of operative time with short aortic cross clamp time and CPB time and hence betters early operative outcomes. Long-term outcome of PV sparing is also promising.…”

Section: Discussionmentioning

confidence: 99%

Clinical outcome of right ventricle outflow tract management for repair of Tetralogy of Fallot with three contemporary surgical strategies

Waqar¹,

Ansari

Khan³

2021

Pak J Med Sci

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Objective: To compare the early operative outcome of TOF repair with three contemporary repair strategies of RVOTO repair i.e. TAP, Mono-cusp construction (MC) in TAP and pulmonary valve repair. Methods: Study is performed at Punjab Institute of Cardiology, Lahore from May 2016 to April 2020. Retrospective analysis of data was performed for patient who underwent TOF repair by three different strategies of RVOT repairs during TOF surgery based on z scoring for pulmonary valve annulus. Group-I underwent trans-annular patch repair, while Group-II and III underwent Mono-cusp repair with autologous pericardium and pulmonary valve repair respectively. Analysis of Variance (ANOVA) and Pearson Chi-Square (PCS) statistics were used to compare the three groups for numeric and categorical variables respectively. Post-hoc t-test and Bonferroni correction were performed for numeric data to compare two groups with each other. Chi-square test was used to perform comparison between groups for categorial variables. Results: ANOVA for aortic cross clamp time, total CPB time, Post-operative mechanical ventilation time, ICU stay and hospital stay showed statistical difference among all three group with p-value less than 0.05 however post hoc T-test showed this variation is limited to post-operative mechanical ventilation only when groups compared with each other. PCS showed there was difference for incidence of difficult weaning from CPB when all three groups compared while there was no difference in operative mortality with p-value of 0.15. However, Group-II comparison with Group-I showed that weaning from CPB was superior in-Group-II with p-value of 0.016. Group-III showed the best statistics for all operative outcome variables among all three groups. Comparison of incidence of post-operative moderate pulmonary regurgitation before discharge between Group-II and Group-III showed significant difference with p-value of 0.0052. Conclusion: PV repair strategy should be employed for RVOT repair of TOF whenever feasible. MC repair showed fewer hours of postoperative mechanical ventilation and higher incidence of easy weaning from CPB when compared to TAP, however its impacts over ICU stay, Hospital stay and operative mortality is not profound in our TOF repair population. doi: https://doi.org/10.12669/pjms.37.5.3961 How to cite this:Waqar T, Ansari MZA, Khan K. Clinical outcome of right ventricle outflow tract management for repair of Tetralogy of Fallot with three contemporary surgical strategies. Pak J Med Sci. 2021;37(5):---------. doi: https://doi.org/10.12669/pjms.37.5.3961 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/3.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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“…8,29 Although there is no consensus on the optimal target annular Z-score, the IBD is conducted up to the target Z-score of zero in both the Bautista and Vida methods and both showed promising results. 8,15 The downside of annulus-sparing methods is a limited utility in patients with hypoplastic pulmonary cusps and/or annuli. In such cases, Vida et al 10 opted for valve-repairing instead of annulussparing to prevent tears from overstretching with IBD.…”

Section: Technical Discussionmentioning

confidence: 99%

Architecture matters: Tissue preservation strategies for tetralogy of Fallot repair

Shimoda

Mathis

Kato

et al. 2021

Journal of Cardiac Surgery

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Background Great variability exists in repair strategies for the tetralogy of Fallot. While transannular patching, as introduced by Kirklin, was a breakthrough for primary repair, pulmonary regurgitation and a need for reoperation have led to the development of methods that preserve the natural morphology of the right ventricular outflow tract. Methods State‐of‐the‐art details of tetralogy of Fallot repair are explained from the standpoint of architectural preservation, especially with regard to sparing native tissue such as the annulus, valve, or infundibulum. Particular attention is given to the latest technical details of each approach, benefits and disadvantages, and any long‐term data available. Results The choice of procedure is complex and unique to each case as transannular patching alone may carry long‐term pulmonary risks. Modifications that spare the annulus, valves, or infundibulum may thus be essential as preservation of natural morphology has resulted in excellent mid‐term results. Conclusions The complexity of tetralogy of Fallot repair demands constant attention to clinical presentation and vigilance against long‐term sequelae. Techniques will continue to improve over time as long‐term data guides the refinement of these innovative surgical methods.

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Valve-Sparing Tetralogy of Fallot Repair With Intraoperative Dilation of the Pulmonary Valve. Mid-Term Results

Cited by 15 publications

References 17 publications

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

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

Clinical outcome of right ventricle outflow tract management for repair of Tetralogy of Fallot with three contemporary surgical strategies

Architecture matters: Tissue preservation strategies for tetralogy of Fallot repair

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