scholarly journals Comparison between the Early Outcome of Fallot Repair with Preservation of the Pulmonary Valve Annulus versus Transannular Patch Repair

2019 ◽  
Vol 87 (12) ◽  
pp. 5065-5073
Author(s):  
MOHAMED ATTYA, M.D.; AMR BASTAWISY, M.D. ◽  
WALEED ISMAIL, M.D. MICHEAL W. REFAAT, M.B.B.Ch.
Keyword(s):  
Pulmonary Valve ◽  
Patch Repair ◽  
Early Outcome ◽  
Transannular Patch ◽  
Valve Annulus

scholarly journals Total Correction of Tetralogy of Fallot: Effect of Transannular Patch on Early Outcome

2018 ◽  
Vol 10 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Md Azizul Islam Khan ◽  
Kazi Abul Hasan ◽  
ABM Abdus Salam ◽  
Quazi Abul Azad ◽  
Sadia Sajmin Siddiqua ◽  
...  
Keyword(s):  
Right Ventricular ◽  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Total Correction ◽  
Early Outcome ◽  
Transannular Patch ◽  
Group A ◽  
Valve Annulus ◽  
Z Value ◽  
Group B

Background: It is arguable whether presence of transannular patch is itself a risk factor for adverse outcome at total correction(repair) of tetralogy of Fallot (TOF).This study intended to compare early outcome of intact pulmonary valve annulus with transannular patching at repair of TOF.Methods: This prospective observational study was conducted from July 2015 to January 2017.40 patients were enrolled in 2 groups- A & B.In group A,14 patients with intact pulmonary valve annulus& in group B, 26 patients with transannular patch. The diameter of pulmonary valve annulus was measured with Hegar dilator and Z value of the measured diameter were calculated from an established published nomogram. Transannular patch was placed if Z value of annular diameter < -3 or post repair operative room right ventricle/left ventricle pressure ratio (P RV/LV)> 0.7.Patients were monitored in the intensive care unit(ICU) and followed up for 3 months following discharge from hospital.Results: Patients of group B were younger and smaller body surface area. There were no significant difference of preoperative variables in terms of peripheral arterial oxygen saturation(SpO2%), haematocrit (%),NYHA functional class, right ventricular hypertrophy, and level & severity of right ventricular out flow tract obstruction. Early out come in terms of duration of ventilation time, inotrope support & ICU stay; post operative morbidity & mortality were more in group B than group A patients. Pulmonary regurgitation & right ventricular dysfunction following transannular patch at repair of TOF plays important role for adverse outcome.Conclusion: Transannular patch is associated with higher morbidity and mortality in total correction of Tetralogy of Fallot.Cardiovasc. j. 2018; 10(2): 194-200

scholarly journals Pulmonary valve restitution following transannular patch repair of tetralogy of Fallot†

2017 ◽  
Vol 25 (6) ◽  
pp. 985-986 ◽  
Author(s):  
Khushboo N Parikh ◽  
Nishant C Shah ◽  
Joseph B Clark ◽  
John L Myers
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Patch Repair ◽  
Transannular Patch

Native Pulmonary Valve Restoration Late Following Transannular Patch Repair of Tetralogy of Fallot

2021 ◽  
pp. 215013512098105
Author(s):  
Oleg Fedevych ◽  
Ramana Dhannapuneni ◽  
Rafael Guerrero ◽  
Attilio Lotto
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Anterior Commissure ◽  
Previous History ◽  
Patch Repair ◽  
Transannular Patch ◽  
Initial Surgery ◽  
History Of ◽  
Easy Operation

We present a surgical case of native pulmonary valve (PV) restoration in a 16-year-old boy with a previous history of transannular patch repair of tetralogy of Fallot in infancy. The PV was restored by approximation of split anterior commissure in the presence of developed and pliable leaflets well preserved after initial surgery. Postoperative echocardiogram showed a competent valve with peak velocity of 2.8 m/s. At six-week follow-up, the patient remained well, and echocardiogram demonstrated a competent PV with decreased velocity of 2.1 m/s across it. We encourage a mindful preservation of PV leaflets whenever it is possible at time of initial repair to implement this relatively easy operation to restore PV function later in life.

Applicability and Durability of Valve-Sparing Tetralogy of Fallot Repair

2021 ◽  
Vol 12 (5) ◽  
pp. 628-634
Author(s):  
Elizabeth H. Stephens ◽  
Brian L. Wolfe ◽  
Abhinav A. Talwar ◽  
Angira Patel ◽  
Joseph A. Camarda ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Demographic Data ◽  
Right Ventricular Outflow Tract ◽  
Patch Repair ◽  
Transannular Patch ◽  
Z Scores ◽  
Valve Sparing ◽  
Tetralogy Of Fallot Repair

Background: Although valve-sparing repair remains ideal for patients with tetralogy of Fallot, the durability of valve-sparing repair and which patients may have been better served with a transannular patch remain unclear. Methods: Retrospective review was performed of tetralogy of Fallot operations at our institution from January 2008 to December 2018. Standard demographic data were collected, including echocardiographic parameters, operative details, and clinical outcomes. Statistical analysis was performed comparing the transannular patch and valve-sparing repair groups. Results: Sixty-seven patients underwent tetralogy of Fallot repair with a median age of 4.5 (3.2-6.0) months and weight of 5.8 (5.2, 6.7) kg. Seventeen (25%) patients underwent transannular patch repair and 50 (75%) patients underwent valve-sparing repair. There was no difference in age or weight between patients who underwent a transannular patch repair and those who underwent a valve-sparing repair. At last follow-up (median 42 months), there was a trend of a higher peak pulmonary valve/right ventricular outflow tract gradient ( P = .06) in the valve-sparing group, but no difference in the pulmonary valve annulus z-scores. Additionally, the pulmonary valve z-scores in the valve-sparing group decreased from −2.3 ± 1.0 on predischarge echocardiogram of to −1.2 ± 1.6 on last follow-up, with the peak gradient on predischarge 23 (0-37) mm Hg remaining stable on last follow-up at 18 (0-29) mm Hg. There was one reoperation: pulmonary valve replacement six years after a transannular patch. Conclusions: Obtaining a postrepair pulmonary valve z-score of −2 yields satisfactory, stable valve-sparing repair with pulmonary valve growth, acceptable gradients, minimal regurgitation, and high freedom from reintervention during follow-up.

Abstract 14576: Durability of Valve-sparing Tetralogy of Fallot Repair

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Elizabeth H Stephens ◽  
Bryan L Wolfe ◽  
Abhinav A Talwar ◽  
Angira Patel ◽  
Joseph Camarda ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Pulmonary Regurgitation ◽  
Pulmonary Valve Replacement ◽  
Patch Repair ◽  
Transannular Patch ◽  
Z Scores ◽  
Valve Sparing ◽  
Tetralogy Of Fallot Repair

Introduction: While valve-sparing repair is ideal for Tetralogy of Fallot (TOF), it’s durability and which patients may benefit from a transannular patch remains unclear. To this end, we reviewed our experience with valve-sparing TOF repair. Methods: Retrospective review was performed of all primary TOF operations at our institution from 1/2008 to 12/2018. Standard demographic, operative, and echo data were collected, along with clinical outcomes. Transannular patch and valve-sparing repair groups were then compared. Results: Sixty-eight patients underwent TOF repair with a mean age of 4.1±2.2 months and weight of 5.7±1.8 kg. There was no difference in age or weight between patients who underwent a transannular patch repair and valve-sparing repair (Table). There was also no difference in the frequency of hypercyanotic spells or beta-blocker use. As expected the pre-operative pulmonary valve size and z-score were significantly different between groups. Bypass times were longer in the transannular patch group (176±40 vs. 144±40 minutes, p=0.005). There were no differences in post-operative complications. At last follow-up (median 41.5 months) there was a trend of a higher peak pulmonary valve gradient (p=0.07) in the valve-sparing group, but no difference in pulmonary valve annulus z-scores. Additionally, the pulmonary valve z-scores in the valve-sparing group decreased from -2.3±1.0 on pre-discharge echocardiogram to -1.2±1.6 on last follow-up, with the peak gradient on pre-discharge 20 (33) mmHg stable on last follow-up at 18 (29) mmHg and degree of pulmonary regurgitation stable. There was one reoperation in the cohort: a pulmonary valve replacement in a patient who had undergone a transannular patch repair 6 years prior. Conclusions: Valve-sparing TOF patients demonstrated stable repairs with pulmonary valve growth, acceptable gradients, minimal regurgitation, and high freedom from re-intervention during follow-up.

scholarly journals Early outcome of transannular patch repair of tetralogy of Fallot with or without pericardial monocusp in pulmonary position

2021 ◽  
Vol 0 (0) ◽  
pp. 0-0
Author(s):  
Ahmed Aboufandoud ◽  
Elhusseiny Gamil ◽  
Monir Amin ◽  
Mohamed Sharaa ◽  
Al Sayed Salem ◽  
...  
Keyword(s):  
Tetralogy Of Fallot ◽  
Patch Repair ◽  
Early Outcome ◽  
Transannular Patch

Optimal Use of Z-Scores to Preserve the Pulmonary Valve Annulus During Repair of Tetralogy of Fallot

2018 ◽  
Vol 9 (3) ◽  
pp. 285-288 ◽  
Author(s):  
Mark Nelson Awori ◽  
Nikita P. Mehta ◽  
Frederick O. Mitema ◽  
Naomi Kebba
Keyword(s):  
Pulmonary Valve ◽  
Operative Procedure ◽  
Data Sets ◽  
Z Score ◽  
Data Set ◽  
Death Studies ◽  
Transannular Patch ◽  
Z Scores ◽  
Different Populations ◽  
Valve Annulus

Objective: The size of the pulmonary annulus measured as a z-score is often used to determine when to insert a transannular patch (TAP). Multiple “cutoffs” are quoted in the literature; this could lead to inappropriate insertion. We aimed to determine whether the use of z-scores derived from different populations may have contributed to the varied “cutoffs” quoted. Methods: PubMed was searched using the terms: “tetralogy,” “Fallot,” “transannular,” “patch,” “mortality,” and “death.” Studies published between January 1, 2005, and October 5, 2017, were included; studies without participants under the age of 18 years and studies that did not describe the operative procedure were excluded. Results: Of 52 papers retrieved, 19 were included representing 2,500 repaired patients; 1,371 (54.8%) had a TAP. Five (26.3%) papers representing 638 patients (25.5%) quoted a z-score “cutoff” and what data set was used; “cutoffs” ranged from −2 to −4 and were derived from 2 different data sets. Three studies quoted a data set that has been shown in previous work to be problematic; the only quoted “cutoffs” of −4 were from two of these studies. Conclusions: Surprisingly few (26.3%) studies mention what pulmonary annulus size “cutoff” was used to decide when to insert a TAP. Z-scores derived from different populations were used by different studies and it is possible that this may have contributed to the varied “cutoffs’ quoted. Recommendations to perform valve-sparing surgery in pulmonary annuli as small as −4 may not be warranted. Future papers should record “cutoffs” employing recommended z-score data set.

Evolving Techniques for the Achievement of Optimal Long-Term Results After Tetralogy of Fallot Repair

2021 ◽  
Vol 12 (1) ◽  
pp. 116-123
Author(s):  
Giovanni Stellin ◽  
Alvise Guariento ◽  
Vladimiro L. Vida
Keyword(s):  
Tetralogy Of Fallot ◽  
Balloon Dilatation ◽  
Pulmonary Valve ◽  
Long Term Results ◽  
Complex Congenital Heart Disease ◽  
Valve Reconstruction ◽  
Valve Annulus ◽  
Teaching Cases ◽  
Tetralogy Of Fallot Repair

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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