Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: mid-term results

Vladimiro L Vida; Alvise Guariento; Biagio Castaldi; Matteo Sambugaro; Massimo A Padalino; Ornella Milanesi; Giovanni Stellin

doi:10.1016/j.jtcvs.2013.10.029

Evolving strategies for preserving the pulmonary valve during early repair of tetralogy of Fallot: mid-term results

J Thorac Cardiovasc Surg. 2014 Feb;147(2):687-94; discussion 694-6. doi: 10.1016/j.jtcvs.2013.10.029. Epub 2013 Dec 4.

Authors

Vladimiro L Vida¹, Alvise Guariento¹, Biagio Castaldi², Matteo Sambugaro³, Massimo A Padalino¹, Ornella Milanesi², Giovanni Stellin⁴

Affiliations

¹ Department of Cardiac, Thoracic and Vascular Surgery, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy.
² Department of Pediatrics, Pediatric Cardiology Unit, University of Padua, Padua, Italy.
³ Statistics Consultant, Department of Cardiac, Thoracic and Vascular Surgery, University of Padua, Padua, Italy.
⁴ Department of Cardiac, Thoracic and Vascular Surgery, Pediatric and Congenital Cardiac Surgery Unit, University of Padua, Padua, Italy. Electronic address: giovannistellin@unipd.it.

PMID: 24314789
DOI: 10.1016/j.jtcvs.2013.10.029

Abstract

Background: The aim of the study was to evaluate our results with pulmonary valve (PV) preservation in selected patients with tetralogy of Fallot (TOF).

Methods: From January 2007, 69 patients who underwent early transatrial TOF repair were enrolled in the study. The patients were divided into 2 groups: PV preservation by PV annulus balloon dilation (group 1) and PV cusp reconstruction after annular incision (group 2).

Results: Thirty-four patients underwent a successful PV annular preservation (49%). Median age at surgery was 113 days (range, 36-521 days) (group-1 vs group-2, P = not significant). Median preoperative PV Z score was -3.15 (range, -0.95 to -5.62) (group-1 vs group-2, P = .03). Median intensive care unit and hospital stays were 3 and 10 days, respectively (group 1 vs group 2, P = not significant). Median follow-up time was 580 days (range, 189-1940 days) (group 1 vs group 2, P = .08). Two patients were reoperated for residual right ventricular outflow tract (RVOT) obstruction (1 in group 1 and 1 in group 2). The remaining patients are alive and well. Median peak RVOT gradient was 25 mm Hg (range, 8-60 mm Hg) (group 1 vs group 2, P = not significant). The degree of PV regurgitation in group 1 was none/mild in 24 patients (80%) and moderate in 6 (20%) and was none/mild in 8 patients (25%), moderate in 11 (34.4%), and severe in 13 (28.6%) in group 2 (P = .001). Median right ventricular fractional area change was 55% (range, 42%-70%) in group 1 and 50% (range, 40%-63%) in group 2 (P = .003).

Conclusions: The integrity and function of the PV can be preserved in selected patients during early repair of TOF by concomitant balloon dilation, leading to a better mid-term right ventricular function.

Keywords: 20; 35; PV; RCA; RV; RVFAC; RVOT; TOF; VSD; pulmonary valve; right coronary artery; right ventricle fraction of area change; right ventricular; right ventricular outflow tract; tetralogy of Fallot; ventricular septal defect.

MeSH terms

Balloon Valvuloplasty* / adverse effects
Balloon Valvuloplasty* / mortality
Cardiac Surgical Procedures / adverse effects
Cardiac Surgical Procedures / methods*
Cardiac Surgical Procedures / mortality
Chi-Square Distribution
Female
Humans
Infant
Infant, Newborn
Length of Stay
Linear Models
Male
Plastic Surgery Procedures* / adverse effects
Plastic Surgery Procedures* / mortality
Postoperative Complications / mortality
Postoperative Complications / therapy
Pulmonary Valve / physiopathology
Pulmonary Valve / surgery*
Reoperation
Retrospective Studies
Risk Factors
Tetralogy of Fallot / diagnosis
Tetralogy of Fallot / mortality
Tetralogy of Fallot / physiopathology
Tetralogy of Fallot / surgery*
Time Factors
Treatment Outcome
Ventricular Function, Right