Congenital: Tetralogy of Fallot
Valve-sparing repair with intraoperative balloon dilation in tetralogy of Fallot: Midterm results and therapeutic implications

Read at the 97th Annual Meeting of The American Association for Thoracic Surgery, Boston, Massachusetts, April 29-May 3, 2017.
https://doi.org/10.1016/j.jtcvs.2017.08.147Get rights and content
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Abstract

Objectives

The significant morbidity of long-term pulmonary regurgitation (PR) has driven the development of pulmonary valve (PV) sparing repair strategies in patients with tetralogy of Fallot (ToF). We assessed mid-term PV function in patients who underwent primary ToF repair with valve-sparing intraoperative balloon dilation (IBD) technique.

Methods

We evaluated 162 consecutive patients with ToF and pulmonary stenosis (ToF-PS) who underwent valve-sparing repair with IBD under 1 year of age.

Results

Median age at surgery was 98 days (interquartile range [IQR], 72-126) and median follow-up was 2.5 years (IQR, 0.6-4.9). Median preoperative PV annulus z score was −2.2 (IQR, −2.5 to −1.8). Twenty-five patients (15.4%) required reintervention for residual valvular stenosis. Multivariable analysis demonstrated preoperative annulus z score less than −2.45 (P = .036) and younger age at surgery (P = .001) were independent risk factors for early reintervention for stenosis. Freedom from at least moderate PR was 77%, 61%, and 43% at 1, 3, and 5 years postrepair. Right ventricular dimensions were not significantly different compared with a matched cohort of patients undergoing transannular patch repair at midterm follow-up.

Conclusions

Patients with ToF-PS who undergo valve-sparing repair with IBD develop progressive PR. Compared with transannular patch repair, the extent of RV dilation at midterm follow-up is not significantly different. Patients younger than 3 months of age and those with an annulus z score less than −2.45 experience higher rates of early reintervention for PV stenosis. In these patient subgroups, alternative strategies should be considered. This study suggests valve-sparing repair with IBD does not preserve long-term PV function in patients with ToF-PS.

Key Words

Tetralogy of Fallot
valve-sparing repair
pulmonary regurgitation
right ventricular dilation

Abbreviations and Acronyms

EDA
end diastolic area
IBD
intraoperative balloon dilation
PR
pulmonary regurgitation
PS
pulmonary stenosis
PV
pulmonary valve
RV
right ventricular
RVOT
right ventricular outflow tract
TAP
transannular patch repair
ToF
tetralogy of Fallot
TOF-PS
tetralogy of Fallot-pulmonary stenosis
TPS
technical performance score
TTE
transthoracic echocardiogram

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Supported by Departmental funds.