Does transatrial-transpulmonary approach improve outcomes compared with transventricular approach in non-neonatal patients undergoing tetralogy of Fallot repair?

2019 ◽  
Vol 29 (6) ◽  
pp. 960-966
Author(s):  
Xin Tao Ye ◽  
Edward Buratto ◽  
Igor E Konstantinov ◽  
Yves d’Udekem
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Exercise Capacity ◽  
Ventricular Arrhythmias ◽  
Observational Studies ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Outflow Tract ◽  
Rv Function ◽  
Tetralogy Of Fallot Repair

AbstractA best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the transatrial-transpulmonary approach to tetralogy of Fallot repair in non-neonatal patients provides superior outcomes compared with the transventricular approach. Altogether, 175 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Two randomized controlled trials (RCTs) and 3 observational studies showed that the transatrial approach resulted in better preservation of right ventricular (RV) function, whereas 4 observational studies showed no significant difference. Three observational studies showed better attenuation of RV dilatation, whereas 3 showed no difference. One RCT and 2 observational studies showed lower incidence of postoperative ventricular arrhythmias, while 1 RCT and 4 observational studies showed no difference. Two observational studies demonstrated greater freedom from reoperation, 1 RCT and 2 observational studies showed no difference, while 1 retrospective study observed a higher incidence of residual RV outflow tract obstruction and lower freedom from reoperation in infants. Two observational studies reported lower risk of requiring pulmonary valve replacement, whereas 2 reported no difference. Three observational studies reported superior exercise capacity, while 1 reported no difference. No difference in long-term survival was demonstrated. The results presented suggest that transatrial repair of tetralogy of Fallot confers superior or equivalent outcomes in terms of preservation of RV function and volume, ventricular arrhythmias, need for pulmonary valve replacement, and exercise capacity compared with transventricular repair. However, the incidence of residual RV outflow tract obstruction may be higher in infants undergoing transatrial repair.

The left heart after pulmonary valve replacement in adults late after tetralogy of Fallot repair

2012 ◽  
Vol 160 (3) ◽  
pp. 165-170 ◽  
Author(s):  
Daniel Tobler ◽  
Andrew M. Crean ◽  
Andrew N. Redington ◽  
Glen S. Van Arsdell ◽  
Christopher A. Caldarone ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Left Heart ◽  
Tetralogy Of Fallot Repair

Timing of pulmonary valve replacement after tetralogy of Fallot repair

2012 ◽  
Vol 10 (7) ◽  
pp. 917-923 ◽  
Author(s):  
Luciane Piazza ◽  
Massimo Chessa ◽  
Alessandro Giamberti ◽  
Claudio Maria Bussadori ◽  
Gianfranco Butera ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Tetralogy Of Fallot Repair

scholarly journals Impact of pulmonary valve replacement on ventricular arrhythmias in patients with tetralogy of Fallot

EP Europace ◽  
2021 ◽  
Vol 23 (Supplement_3) ◽  
Author(s):  
F Bessiere ◽  
K Gardey ◽  
G Duthoit ◽  
L Koutbi ◽  
F Labombarda ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Valve Replacement ◽  
Survival Data ◽  
Ventricular Arrhythmias ◽  
Recurrent Events ◽  
Pulmonary Valve ◽  
Pulmonary Valve Replacement ◽  
Cardiac Monitoring ◽  
Icd Therapy ◽  
The Impact

Abstract Funding Acknowledgements Type of funding sources: Public grant(s) – National budget only. Main funding source(s): INSERM - French Society of Cardiology OnBehalf DAIT4F Investigators Background Sudden cardiac death is a major cause of death in tetralogy of Fallot (TOF) and right ventricular overload is commonly considered as a potential trigger for ventricular arrhythmias. Purpose We aimed to assess the impact of pulmonary valve replacement (PVR) on ventricular arrhythmias burden using a population of TOF patients with continuous cardiac monitoring by implantable cardioverter defibrillator (ICD). Methods Nationwide French registry including all TOF patients with an ICD. Survival data with recurrent events were used to compare the burden of appropriate ICD therapies before and after PVR in patients who underwent PVR over the study period. Results A total of 165 patients (mean age 42.2 ± 13.3 years, 70.1% males) were included from 40 centers. Over a median (IQR) follow-up period of 6.8 (2.5-11.4) years, 26 (15.8%) patients underwent PVR. Among those patients, 18 (69.2%) experienced at least one appropriate ICD therapy. When considering all ICD therapies delivered before (n = 62) and after (n = 16) PVR, the burden of ICD appropriate therapies was significantly lower after PVR (HR 0.21, 95%CI 0.08-0.56, p = 0.002). In the overall cohort, PVR before ICD implantation was also independently associated with a lower risk of appropriate ICD therapy in primary prevention patients (HR 0.29, 95%CI 0.10-0.89, p = 0.031). Conclusions In this cohort of high-risk TOF patients implanted with an ICD, the burden of appropriate ICD therapies was significantly reduced after PVR. While optimal indications and timing for PVR are debated, these findings suggest the importance of considering ventricular arrhythmias in the overall making-decision process. Abstract Figure.

Sign in / Sign up

Export Citation Format

Share Document