scholarly journals The immediate results of valve-sparing complete repair of tetralogy of Fallot

2019 ◽  
Vol 23 (1) ◽  
pp. 9
Author(s):  
I. A. Kozyrev ◽  
A. A. Morozov ◽  
E. V. Grekhov ◽  
I. A. Averkin ◽  
M. L. Gordeev ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Tetralogy Of Fallot ◽  
Conflict Of Interest ◽  
Pulmonary Valve ◽  
Early Postoperative Period ◽  
Cardiopulmonary Bypass Time ◽  
Complete Repair ◽  
Z Scores ◽  
Valve Sparing ◽  
Repair Group

<p><strong>Aim.</strong> The present study aimed to evaluate the immediate results after the primary valve-sparing complete repair of tetralogy of Fallot.<br /><strong>Methods.</strong> The study included patients with tetralogy of Fallot who were aged &lt;6 months and who underwent primary complete repair between January 2017 and December 2018. According to the surgical approach, the patients were divided into two groups: valve-sparing repair and transannular plasty. Data were obtained from medical records and included echocardiography findings and surgical information. The dimensions of the pulmonary valve were assessed using Z-scores.<br /><strong>Results.</strong> In total, 38 patients were included in this study. Among these, 25 (66%) patients were included in the valve-sparing repair group. The valve-sparing repair group had lower cardiopulmonary bypass time, epinephrine support duration, and pulmonary valve Z-scores than the transannular plasty group. Additionally, the valve-sparing repair group had a significantly higher postoperative pulmonary valve Z-score than the preoperative score. <br /><strong>Conclusion.</strong> Valve-sparing complete repair of tetralogy of Fallot is possible in the majority of patients. Pulmonary valve preservation reduces cardiopulmonary bypass time and provides a more stable early postoperative period by reducing the epinephrine support duration.</p><p>Received 13 March 2019. Revised 24 March 2019. Accepted 8 April 2019.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p>

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 Assessment of pulmonary arteries in patients with tetralogy of Fallot

2018 ◽  
Vol 22 (4) ◽  
pp. 48
Author(s):  
I. A. Kozyrev ◽  
A. A. Morozov ◽  
A. K. Latypov ◽  
A. V. Vasilets ◽  
N. A. Kotin ◽  
...  
Keyword(s):  
Computed Tomography ◽  
Tetralogy Of Fallot ◽  
Surgical Management ◽  
Conflict Of Interest ◽  
Pulmonary Arteries ◽  
Z Score ◽  
Complete Repair ◽  
Z Scores ◽  
Left And Right

<p><strong>Aim.</strong> The study aimed to evaluate the size of pulmonary arteries in patients with tetralogy of Fallot during preoperative and intraoperative stages and to find out the influence of preoperative sizes on the surgical management.<strong></strong></p><p><strong>Methods. </strong>Between January 2015 and May 2018, 50 patients with tetralogy of Fallot younger seven months underwent primary complete or palliative repair. The data obtained from patients' files and include echocardiography, computed tomography and surgical reports. Dimensions of right and left pulmonary arteries were analyzed by calculating the Z-score and Nakata indices.<strong></strong></p><p><strong>Results.</strong> Z-scores of the left and right pulmonary arteries were significantly smaller by echocardiography comparing to computed tomography (p&lt;0.01). Z-scores of left and right pulmonary arteries measuring by computed tomography were also smaller than the size measured during surgery (p=0.05). Nakata index according to computed tomography was significantly smaller (p&lt;0.05) than this index calculated from surgical reports.<strong></strong></p><p><strong>Conclusion.</strong> In patients with tetralogy of Fallot, the size of pulmonary arteries according to the visualization methods is smaller than size measured during surgery. Intraoperative sizing of pulmonary arteries could influence surgical management, expanding indications for complete repair in some patients.</p><p>Received 6 July 2018. Revised 24 August 2018. Accepted 28 August 2018.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Author declare no conflict of interest.</p><p><strong>Acknowledgment</strong><br />We would like to express our gratitude to Ya.A. Yermolenko for Figure 1 used in the article.</p>

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

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.

Complete Repair of Tetralogy of Fallot with Absent Pulmonary Valve Including the Role of Airway Stenting

1985 ◽  
Vol 2 (2) ◽  
pp. 82-91
Author(s):  
Ali Dodge-Khatami ◽  
Carl L. Backer ◽  
Lauren D. Holinger ◽  
Harris P. Baden ◽  
Constantine Mavroudis
Keyword(s):  
Tetralogy Of Fallot ◽  
Pulmonary Valve ◽  
Absent Pulmonary Valve ◽  
Complete Repair ◽  
Airway Stenting

scholarly journals Analysis of direct results of reoperative coronary artery bypass surgery

2021 ◽  
Vol 25 (1) ◽  
pp. 85
Author(s):  
M. L. Gordeev ◽  
V. K. Grebennik ◽  
I. K. Ismail-zade ◽  
G. I. Ishmukhametov ◽  
I. Yu. Ivanov ◽  
...  
Keyword(s):  
Cardiopulmonary Bypass ◽  
Respiratory Failure ◽  
Coronary Artery ◽  
Postoperative Complications ◽  
Conflict Of Interest ◽  
Artery Bypass ◽  
Early Postoperative Period ◽  
Cardiovascular Failure ◽  
Off Pump ◽  
Group B

<p><strong>Aim.</strong> To compare the immediate results of treatment of patients after redo coronary artery bypass grafting (reCABG) off pump and with cardiopulmonary bypass.</p><p><strong>Methods.</strong> The retrospective study included 138 patients who underwent isolated reCABG for recurrence of angina pectoris in the period of 2013 to 2019 at the Almazov Research Centre. The operation was performed with cardiopulmonary bypass using isothermal blood cardioplegia in 74 cases (group A). Sixty-four operations were performed without cardiopulmonary bypass (group B). The primary endpoint was a major adverse cardiovascular event (e.g. myocardial infarction, acute cerebrovascular accident, cardiovascular death) during hospitalisation. Secondary endpoints were cardiovascular failure, respiratory failure, renal failure, and wound healing complications during hospitalisation.</p><p><strong>Results.</strong> Redo CABG with cardiopulmonary bypass compared with CABG off pump was more often complicated by cardiovascular failure (39.2% versus 20.3%, p = 0.043), respiratory failure (7.8% versus 2.7%, p = 0.047), and postpericardiotomy syndrome (13.5% versus 0%, p = 0.047). The revascularisation index was higher in the group of reCABG off pump (2.9) compared to the group of reCABG with cardiopulmonary bypass (2.4). In the early postoperative period there was a decrease in the duration of inpatient treatment and stay in the intensive care unit, the duration of surgery, as well as a lower incidence of postoperative complications in group B.</p><p><strong>Conclusion.</strong> Redo CABG showed satisfactory results in the early postoperative period. Performing reCABG off pump was advantageous and was associated with a decrease in the incidence of postoperative complications.</p><p>Received 23 June 2020. Revised 9 September 2020. Accepted 10 September 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong> <br />Conception and design: I.K. Ismail-zade, V.K. Grebennik<br />Data collection and analysis: I.K. Ismail-zade, D.G. Zavarzina, N.R. Abutalimova<br />Drafting the article: I.K. Ismail-zade, I.Yu. Ivanov, G. I. Ishmukhametov<br />Critical revision of the article: V.K. Grebennik, M,l, Gordeev<br />Final approval of the version to be published: M.L. Gordeev, V.K. Grebennik, I.K. Ismail-zade, G.I. Ishmukhametov, I.Yu. Ivanov, N.R. Abutalimova, D.G. Zavarzina</p>

scholarly journals Bovine monocusp in surgery for tetralogy of Fallot

2020 ◽  
Vol 24 (4) ◽  
pp. 42
Author(s):  
A. A. Svobodov ◽  
E. G. Levchenko ◽  
G. S. Netalieva ◽  
V. T. Kostava ◽  
M. V. Zelivyanskaya ◽  
...  
Keyword(s):  
Right Ventricle ◽  
Pressure Gradient ◽  
Tetralogy Of Fallot ◽  
Conflict Of Interest ◽  
Pulmonary Valve ◽  
Long Term Results ◽  
Residual Pressure ◽  
Valve Regurgitation ◽  
One Year

<p><strong>Aim.</strong> To evaluate the functionality of a bovine monocusp in surgery for tetralogy of Fallot.</p><p><strong>Methods.</strong> We analyzed the results of surgical treatment in the early postoperative period in eight infants and one year after surgery in seven infants (age range, 0–12 months; mean weight = 7.5 ± 2.3 kg). We used echocardiography to evaluate the residual pressure gradient between the right ventricle and the pulmonary artery, the degree of regurgitation on the pulmonary valve after surgery and to calculate Z-score and the fibrous ring diameter of the pulmonary valve in the late follow-up period. The degree of insufficiency was assessed by the width and depth of the regurgitation flow using the color Doppler mode.</p><p><strong>Results.</strong> The pressure gradient on the eve of discharge did not exceed 25 mmHg for any patient. Pulmonary valve regurgitation was mild in four patients and moderate in the remaining patients. Seven children passed the observation one year after surgery. In one case, we discovered a right ventricle outflow tract obstruction. In other cases, the systolic pressure gradient did not exceed 25 mmHg. Four patients in the late follow-up period had severe valve regurgitation. Despite such valve insufficiency, the leaflet mobility in the bovine jugular vein patch was normal.</p><p><strong>Conclusion.</strong> Early postoperative results for reconstructive surgery to repair tetralogy of Fallot with a bovine monocusp were promising. However, long-term results are comparable with those using other materials. The mobility of the native leaflet remains full even a year after surgery. Consequently, we have positive prospects in material improvement for making patches with native monocusps.</p><p>Received 14 May 2020. Revised 8 June 2020. Accepted 10 June 2020.</p><p><strong>Funding:</strong> The study did not have sponsorship.</p><p><strong>Conflict of interest:</strong> Authors declare no conflict of interest.</p><p><strong>Author contributions</strong><br />Conception and study design: A.A. Svobodov, E.G. Levchenko, V.T. Kostava<br />Data collection and analysis: G.S. Netalieva, M.V. Zelivyanskaya<br />Statistical analysis: E.G. Levchenko, M.V. Zelivyanskaya<br />Drafting the article: A.A. Svobodov, V.S. Rasumovsky<br />Critical revision of the article: V.S. Rasumovsky<br />Final approval of the version to be published: A.A. Svobodov, E.G. Levchenko, G.S. Netalieva, V.T. Kostava, M.V. Zelivyanskaya, V.S. Rasumovsky</p>

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