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Impact of Annulus-Sparing on Surgical Adequacy of Pulmonary Valve in Complete Repair of Tetralogy of Fallot with Right Ventricular Outflow Tract Incision

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Abstract

Today, strategy of repair remains controversial and rare analyses on annular integrity associated with outcomes in complete repair by RVOT incision were performed in a large TOF cohort in China. This is a retrospective cohort study involving patients with TOF who had undergone complete repair by RVOT incision between January 2012 and December 2017 in Fuwai hospital. The primary outcome was a composite of reintervention, significant pulmonary regurgitation (PR) and significant annular peak gradient (APG). Multivariate Cox proportional-hazards model analyses were used to assess the relationships between annular integrity and outcomes. In total, 1673 survival patients with the median age of 318 days were included, and 1002 were male. During a median follow-up of 49 months, 538 participants developed the primary outcome (27 reinterventions). Multivariate Cox analyses showed that compared with AS, TAP was associated with an increased risk of primary outcome (adjusted HR, 1.94 [95% CI 1.60–2.37]) and the results remained unchanged even in most subgroups defined. In secondary outcomes analyses, TAP is associated with a higher risk of reintervention (adjusted HR, 3.32 [95% CI 1.25–8.79]) and significant PR (adjusted HR, 2.51 [95% CI 2.00–3.16]). However, TAP is not associated with a decreased risk of significant APG (adjusted HR, 1.33 [95% CI 0.94–1.88]). PVA integrity preservation is important in complete repair of TOF with RVOT incision. TAP is associated with a higher risk of reintervention and significant PR, and with a similar risk of significant APG. Significant APG in AS patients at discharge has a downtrend over time.

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Registration Number: https://www.chictr.org.cn number, ChiCTR2000033234.

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Funding

The study was supported by the National Key R&D Program of China (2017YFC1308100) and Central Public-interest Scientific Institution Basal Research Fund (2019XK320050).

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  1. Xianchao Jiang, Jinyang Liu and Bo Peng contributed equally to this article.

Authors and Affiliations

  1. Center for Pediatric Cardiac Surgery, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167A, Beilishilu, Xi Cheng District, Beijing, China

    Xianchao Jiang, Jinyang Liu, Bo Peng, Shoujun Li, Jun Yan & Qiang Wang

  2. Department of Cardiac Surgery, Yunnan Fuwai Cardiovascular Hospital, Kunming, China

    Heng Zhang & Qiang Wang

Authors
  1. Xianchao Jiang
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  2. Jinyang Liu
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  4. Heng Zhang
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  5. Shoujun Li
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  6. Jun Yan
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  7. Qiang Wang
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Correspondence to Qiang Wang.

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Jiang, X., Liu, J., Peng, B. et al. Impact of Annulus-Sparing on Surgical Adequacy of Pulmonary Valve in Complete Repair of Tetralogy of Fallot with Right Ventricular Outflow Tract Incision. Pediatr Cardiol 42, 379–388 (2021). https://doi.org/10.1007/s00246-020-02493-x

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  • DOI: https://doi.org/10.1007/s00246-020-02493-x

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