Comparison of Right Ventricular Outflow Tract Reconstruction Techniques on Mid-Term Pulmonic Valve Fate

Abstract

Introduction: The pulmonic valve-sparing technique (PVS) is an emerging approach of right ventricular outflow tract reconstruction in tetralogy of Fallot (TOF) correction aimed at reducing the incidence of pulmonic regurgitation (PR) and the need for subsequent reintervention. This study aims to compare the long-term occurrence of moderate to severe PR/stenosis (PR/PS) between three different approaches. Patients and Methods: We conducted a retrospective cohort study involving 173 patients who underwent TOF correction at Chiang Mai University hospital between January 2006 and December 2016. The patients were divided into three groups: transannular patch (TAP; n = 88, 50.9%), monocusp insertion (MCI; n = 40, 23.1%), and PVS (n = 45, 26%). The study assessed freedom from moderate to severe PR/PS. Results: The median overall follow-up time was 79.8 months (interquartile range: 50.7-115.5 months. The PVS exhibited larger PV Z-score (−2.6 ± 2.3 mm, P < .001), with predominantly tricuspid morphology (64.4%). The PVS had significantly shorter median ventilator time, intensive care unit stay, hospital stay, and longer median follow-up time. Postoperative moderate-severe PR was lower in the PVS group (P < .001), with no significant difference in PS (P = .356) and complications among the groups. Freedom from moderate-severe PR/PS was longer in the MCI group (2.8, 0.2-42.3 months vs 30.9, 0.2-50.9 months, respectively). Multivariable analysis showed TAP and MCI had a higher risk of developing moderate-severe PR (hazard ratio [HR] 2.51; 95% confidence interval [CI] 1.23-5.13 vs HR 1.41; 95%CI 0.59-3.38) but lower risk of moderate-severe PS (HR 0.14; 95%CI 0.02-0.9 vs HR 0.39; 95%CI 0.05-3.19). Conclusion: Pulmonic valve-sparing reconstruction showed promise in preventing late moderate-severe PR in patients with favorable PV anatomy. However, it should be noted that this technique is associated with a higher incidence of PS.

Keywords

CHD valve lesions congenital heart disease (CHD)congenital heart surgery heart valve pulmonary stenosis pulmonary valve

Get full access to this article

View all access options for this article.

References

Park

Kim

, et al. Symptomatic young infants with tetralogy of fallot: one-stage versus staged repair. J Card Surg. 2010;25(4):394-399.

Sarris

Comas

Tobota

Maruszewski

. Results of reparative surgery for tetralogy of Fallot: data from the European Association for Cardio-Thoracic Surgery Congenital Database. Eur J Cardiothorac Surg. 2012;42(5):766-774. discussion 74.

Bacha

Scheule

Zurakowski

, et al. Long-term results after early primary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2001;122(1):154-161.

Al Habib

Jacobs

Mavroudis

, et al. Contemporary patterns of management of tetralogy of Fallot: data from the Society of Thoracic Surgeons Database. Ann Thorac Surg. 2010;90(3):813-819. discussion 9–20.

Arafat

Elatafy

Elshedoudy

Zalat

Abdallah

Elmahrouk

. Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair. J Cardiothorac Surg. 2018;13(1):14. doi:10.1186/s13019-018-0702-0

Gatzoulis

Balaji

Webber

, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000;356(9234):975-981.

Sasson

Houri

Raucher Sternfeld

, et al. Right ventricular outflow tract strategies for repair of tetralogy of Fallot: effect of monocusp valve reconstruction. Eur J Cardiothorac Surg. 2013;43(4):743-751.

Brown

Ruzmetov

Vijay

Rodefeld

Turrentine

. Right ventricular outflow tract reconstruction with a polytetrafluoroethylene monocusp valve: a twelve-year experience. J Thorac Cardiovasc Surg. 2007;133(5):1336-1343.

Stewart

Backer

Young

Mavroudis

. Tetralogy of Fallot: results of a pulmonary valve-sparing strategy. Ann Thorac Surg. 2005;80(4):1431-1438. discussion 8–9.

10.

Vida

Guariento

Castaldi

, et al. Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: mid-term results. J Thorac Cardiovasc Surg. 2014;147(2):687-694. discussion 94–6.

11.

Hoashi

Kagisaki

Meng

, et al. Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus. J Thorac Cardiovasc Surg. 2014;148(3):802-808. discussion 8–9.

12.

Bacha

. Valve-sparing or valve reconstruction options in tetralogy of Fallot surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2017;20:79-83.

13.

Awori

Mehta

Mitema

Kebba

. Optimal use of Z-scores to preserve the pulmonary valve annulus during repair of tetralogy of Fallot. World J Pediatr Congenit Heart Surg. 2018;9(3):285-288.

14.

Galea

Aquilina

Grech

. Risk factors for QRS prolongation after repaired tetralogy of Fallot. Hell J Cardiol. 2006;47(2):66-71.

15.

Egbe

Taggart

Reddy

YNV

, et al. Assessment and implications of right ventricular afterload in tetralogy of Fallot. Am J Cardiol. 2019;124(11):1780-1784.

Supplementary Material

Please find the following supplemental material available below.

For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.

For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.

0.00 MB

0.02 MB

0.07 MB