Long-term results of pulmonary valve annular enlargement with valve repair in tetralogy of Fallot

Several techniques designed to improve long-term results after repair of tetralogy of Fallot are described. We have recently embarked on a program focused on preserving the native pulmonary valve. Here, combined techniques are described in detail, including intraoperative pulmonary valve balloon dilatation, pulmonary valve reconstruction by delamination and resuspension of the leaflets, and pulmonary valve annulus augmentation. As with any other complex congenital heart disease, senior surgeons should select teaching cases, starting from the less severe side of the spectrum.

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Surgical Repair of Tetralogy of Fallot With Absent Pulmonary Valve: Favorable Long-Term Results

Seminars in Thoracic and Cardiovascular Surgery ◽

10.1053/j.semtcvs.2019.05.022 ◽

2019 ◽

Vol 31 (4) ◽

pp. 847-849 ◽

Cited By ~ 1

Author(s):

Dan M. Dorobantu ◽

Carla Stoicescu ◽

Robert M. Tulloh ◽

Serban C. Stoica

Keyword(s):

Tetralogy Of Fallot ◽

Surgical Repair ◽

Pulmonary Valve ◽

Long Term Results ◽

Absent Pulmonary Valve

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Mid- to long-term follow-up of pulmonary valve replacement with BioIntegral injectable valve

European Journal of Cardio-Thoracic Surgery ◽

10.1093/ejcts/ezaa337 ◽

2020 ◽

Author(s):

Simone Ghiselli ◽

Cristina Carro ◽

Nicola Uricchio ◽

Giuseppe Annoni ◽

Stefano M Marianeschi

Keyword(s):

Cardiopulmonary Bypass ◽

Right Ventricular ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Stenosis ◽

Pulmonary Regurgitation ◽

Pulmonary Valve Replacement

Abstract OBJECTIVES Chronic pulmonary valve (PV) regurgitation is a common late sequela after repair of congenital heart diseases like tetralogy of Fallot or pulmonary stenosis, leading to right ventricular dilatation and failure and increased late morbidity and mortality. Timely reoperation may lead to a complete right ventricular recovery. An injectable PV allows pulmonary valve replacement, with or without cardiopulmonary bypass, under direct observation, thereby minimizing the impact of surgery on cardiac function. The aim of this study was to evaluate the feasibility and mid- to long-term clinical outcomes with this device. METHODS From April 2007 to October 2019, a total of 85 symptomatic patients with severe pulmonary regurgitation or pulmonary stenosis underwent pulmonary valve replacement with an injectable stented pulmonary prosthesis. Data were collected from the international proctoring registry. Mean patient age was 26.7 years. The underlying diagnosis was repaired tetralogy of Fallot in 69.4% patients; moderate or severe pulmonary regurgitation was present in 72.9%. All patients had echocardiographic scans before the operation and during the follow-up period. A total of 54.1% patients also had preoperative/postoperative cardiac magnetic resonance imaging (MRI) or catheterization; 25.9% had off-pump implants. In 53% patients, pulmonary valve replacement was associated with the repair of other cardiac defects. RESULTS Minor postoperative complications were observed in 10.8% patients. The overall mortality rate was 2.3%; mortality after valve replacement was linked to a severe cardiac insufficiency and it was not related to a prosthesis failure; 1 prosthesis was explanted from 1 patient because of endocarditis, and 6% of patients developed PV stenosis; minor complications occurred in 4.8%. The mean follow-up period was 4.8 years (2 months–12.7 years); 42% of the patients were followed for more than 5 years. Follow-up echocardiography and cardiac MRI showed a significant reduction in RV size and low gradients across the PV. CONCLUSIONS An injectable PV may be implanted without cardiopulmonary bypass and in a hybrid operating theatre with minimal surgical impact. The bioprosthesis, available up to large sizes, has a low profile, laminar flow and no risk of coronary artery compression. Incidence of endocarditis is rare. The lack of a suture ring permits the implant of a relatively larger prosthesis, thereby avoiding a right ventricular outflow tract obstruction. This device permits future percutaneous valve-in-valve procedures, if needed. Results concerning durability are encouraging, and mid- to long-term haemodynamic performance is excellent.

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Similar long-term results of mitral valve repair for anterior compared with posterior leaflet prolapse

Journal of Thoracic and Cardiovascular Surgery ◽

10.1016/j.jtcvs.2005.09.040 ◽

2006 ◽

Vol 131 (2) ◽

pp. 364-370 ◽

Cited By ~ 65

Author(s):

Michele De Bonis ◽

Roberto Lorusso ◽

Elisabetta Lapenna ◽

Samer Kassem ◽

Giuseppe De Cicco ◽

...

Keyword(s):

Mitral Valve ◽

Mitral Valve Repair ◽

Long Term Results ◽

Posterior Leaflet ◽

Valve Repair ◽

Leaflet Prolapse

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Long-term Results Following Mitral Valve Repair for Degenerative Mitral Regurgitation

Heart Lung and Circulation ◽

10.1016/j.hlc.2008.05.160 ◽

2008 ◽

Vol 17 ◽

pp. S69

Author(s):

Michael Gardner ◽

Kenneth Hossack

Keyword(s):

Mitral Valve ◽

Mitral Regurgitation ◽

Mitral Valve Repair ◽

Long Term Results ◽

Valve Repair

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Long-Term Outcome Following Pulmonary Valve Replacement in Repaired Tetralogy of Fallot

World Journal for Pediatric and Congenital Heart Surgery ◽

10.1177/21501351211027857 ◽

2021 ◽

Vol 12 (5) ◽

pp. 616-627

Author(s):

Alqasem Fuad H. Al Mosa ◽

Sreenath Madathil ◽

Pierre-Luc Bernier ◽

Christo Tchervenkov

Keyword(s):

Adverse Events ◽

Tetralogy Of Fallot ◽

Valve Replacement ◽

Pulmonary Valve ◽

Pulmonary Valve Replacement ◽

Term Outcome ◽

Long Term Outcome ◽

Repaired Tetralogy Of Fallot ◽

The Mean

Background: Late pulmonary valve replacement following repair of tetralogy of Fallot may become necessary in patients with chronic pulmonary insufficiency. There is limited information on the long-term outcome of these prostheses, which is the focus of this study. Methods: We conducted a retrospective study of patients with repaired tetralogy of Fallot who underwent pulmonary valve replacement from 1990 to 2015 in our institution. We investigated imaging and clinical parameters including mortality and late adverse events (reintervention [surgical or transcatheter]), infective endocarditis, or arrhythmias requiring device implantation or ablation. Results: There were 69 patients divided into 3 groups: Carpentier-Edwards (n = 14), Contegra (n = 40), and pulmonary homograft (n = 15). The mean age at the time of pulmonary valve replacement was 21 ± 12 years. The mean follow-up was 8.5 ± 4.7 years. The mean preoperative and postoperative right ventricular end-diastolic volume index was 210 ± 42 and 120 ± 24 mL/m2, respectively. There were no mortalities. Late adverse events were observed in 23 (33%) patients: 15 (22%) reintervention (surgical or transcatheter), 11 (16%) endocarditis, and 11 (16%) arrhythmias. Overall, 1-, 5-, and 10-year freedom from surgical reintervention was 98.5%, 93.6%, and 79.3%, respectively. The Contegra group had significantly higher pulmonary valve gradients, a higher risk of developing late adverse events compared to Carpentier-Edwards ( P = .046) and pulmonary homograft ( P = .055) in multivariate analysis and increased risk for reintervention in the univariate analysis (hazard ratio: 3.4; 95% CI: 0.92-13; P value.066). Conclusion: Pulmonary valve replacement in patients with repaired tetralogy of Fallot has acceptable short- and intermediate-term outcomes. Contegra prosthesis had a higher risk of late adverse events with higher pulmonary valve gradients.

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Early and long-term results of biventricular repair of Tetralogy of Fallot with or without pulmonary atresia

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2018.06.016 ◽

2018 ◽

Vol 10 (3-4) ◽

pp. 280

Author(s):

Mansour Mostefa Kara ◽

Olivier Villemain ◽

Mathilde Meot ◽

Olivier Raisky ◽

Damien Bonnet

Keyword(s):

Tetralogy Of Fallot ◽

Pulmonary Atresia ◽

Long Term Results ◽

Biventricular Repair

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Long-term results after palliative intra-cardiac repair for tetralogy of Fallot and diminutive pulmonary arteries

Cardiology in the Young ◽

10.1017/s1047951119001392 ◽

2019 ◽

Vol 29 (8) ◽

pp. 1036-1039

Author(s):

Yoichi Kawahira ◽

Kyoichi Nishigaki ◽

Koji Kagisaki ◽

Takuji Watanabe ◽

Kazuki Tanimoto

Keyword(s):

Right Ventricle ◽

Tetralogy Of Fallot ◽

Arterial Oxygen Saturation ◽

Pulmonary Arteries ◽

Systolic Pressure ◽

Cardiac Repair ◽

Long Term Results ◽

Arterial Oxygen ◽

The Right

AbstractBackground:In patients with tetralogy of Fallot with the diminutive pulmonary arteries, we sometimes have to give up the complete intra-cardiac repair due to insufficient growth of the pulmonary arteries. We have carried out palliative intra-cardiac repair using a fenestrated patch.Methods:Of all 202 patients with tetralogy of Fallot in our centre since 1996, five patients (2.5%) with the diminutive pulmonary arteries underwent palliative intra-cardiac repair using a fenestrated patch. Mean operative age was 1.8 years. Previous operation was Blalock–Taussig shunt in 4. At operation, the ventricular septal defect was closed using a fenestrated patch and the right ventricular outflow tract was enlarged. Follow-up period was 9.8 ± 2.6 years.Results:There were no operative and late deaths. Fenestration closed spontaneously on its own in four patients 2.7 ± 2.1 years after the intra-cardiac repair with a stable haemodynamics; however, the last patient with the smallest pulmonary artery index had supra-systemic pressure of the right ventricle post-operatively. The fenestration was emergently enlarged. Systemic arterial oxygen saturation was significantly and dramatically increased from 83.5 to 94% after the palliative intra-cardiac repair, and to 98% at the long term. A ratio of systolic pressure of the right ventricle to the left was significantly decreased to 0.76 ± 0.12 at the long term. Now all five patients were Ross classification class I.Conclusion:Although frequent catheter and surgical interventions were needed after the palliative intra-cardiac repair, this repair might be a choice improving quality of life with good results in patients with tetralogy of Fallot associated with the diminutive pulmonary arteries.

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