Early and late outcomes of total repair of tetralogy of Fallot: risk factors for late right ventricular dilatation

Kim, Hyungtae; Sung, Si Chan; Kim, Si-Ho; Chang, Yun Hee; Lee, Hyoung Doo; Park, Ji Ae; Lee, Young Seok

doi:10.1093/icvts/ivt361

Cited by 49 publications

(37 citation statements)

References 22 publications

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“…Kim et al. [19] reported a 5% incidence of pleural effusion that required tapping. The surgical techniques for primary repair to preserve RV function, reduce arrhythmia, and optimize functional status that are still evolving and a definitive consensus is lacking [20] .…”

Section: Discussionmentioning

confidence: 99%

Surgery for Tetralogy of Fallot in Adults: Early Outcomes

Khan¹,

Tufail²,

Afridi³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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ObjectiveTo study the in-hospital outcome of adult patients who had undergone surgical repair for Tetralogy of Fallot.MethodsA retrospective descriptive study was conducted at the Punjab Institute of Cardiology searching the hospital records. All those adult patients who had undergone repair for Tetralogy of Fallot from January 2012 to December 2014 were included in the study. All the patients were operated by the same surgical team. Patients who underwent primary repair as well as those with previous palliative procedures were included in the study. Thirty days outcome was studied by recording variables from the database. Data was analysed using Statistical Package for Social Sciences version 16.ResultsA total of 80 patients was included in the study, in which there were 48 (60%) male patients and 32 (40%) female patients. Mean age was 21±0.21 years. Those with previous palliation were 15 (18.75%). The associated problems observed were: atrial septal defect 27 (33.75%), right aortic arch 30 (37.5%), patent ductus arteriosus 6 (7.5%) and double outlet right ventricle 3 (3.75%). In-hospital mortality recorded was 7 (8%). Postoperative complications encountered were low cardiac output syndrome 9 (11.25%), pleural effusion requiring tapping 3 (3.75%), reoperation for bleeding 3 (3.8%), pulmonary regurgitation (moderate to severe) 20 (25%) which occurred in the transannular patch group only and atrial arrhythmia 4 (5%).ConclusionA large number of adult patients are still operated for tetralogy of Fallot in Pakistan. With increasing experience in the technique the mortality and morbidity is comparable to international literature.

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Section: Discussionmentioning

confidence: 99%

Surgery for Tetralogy of Fallot in Adults: Early Outcomes

Khan¹,

Tufail²,

Afridi³

et al. 2016

Brazilian Journal of Cardiovascular Surgery

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“…Some investigators have concluded that TAP repair is a risk factor for late RV dilatation, ventricular arrhythmias and SCD in patients who have undergone repair of TOF (15,16). TAP repair provides excellent relief of the RVOT obstruction in TOF patients, but it can results in PR.…”

Section: Discussionmentioning

confidence: 99%

Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure gradient

et al. 2017

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Background: To determine potential predictors of ventricular tachyarrhythmia and sudden cardiac death (SCD) occurring late after repair of tetralogy of Fallot (TOF). Methods: Since 1964, 415 patients had undergone total repair for TOF at Niigata University Hospital. Of these, 89 patients who were followed for more than 10 years at our institute were retrospectively reviewed. Results: The mean follow-up period was 24.3 years. During the study period, one patient died of cerebral bleeding, and two patients had SCD. The overall survival rates at 20, 30, and 40 years were 100%, 94.6%, and 94.6%, respectively. Eight (9.0%) patients required re-intervention during the late period associated with right ventricular outflow (n=4), tricuspid valve (n=3), aortic valve (n=2), and others (n=2). Ten (11.2%) patients had a history of ventricular tachycardia (VT) or ventricular fibrillation (VF), and six underwent implantation of an implantable cardiac defibrillator. Multivariate analysis selected the change rate of QRS duration [ms/year; odds ratio (OR), 2.44; 95% confidence interval (CI): 1.28-4.65; P=0.007] and the pressure gradient at tricuspid valve regurgitation on echocardiography (OR, 1.12; 95% CI: 1.02-1.22; P=0.017) as risk factors for VT/VF or SCD. Trans-annular patch (TAP) repair was not an independent risk factor for ventricular arrhythmia. Conclusions: The combination of rapid change rate of QRS duration and higher-pressure gradient at tricuspid regurgitation were risk factors for ventricular tachyarrhythmia late after TOF repair. Adequate surgical or catheter intervention for pressure and volume load in the right ventricle might decrease the prevalence of VT/VF and SCD.

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“…Repair of the PV (after the TAP procedure) is the most suitable of options for reconstruction of the RVOT. 16 It is important to stress that the median age of repair in this group of TOF patients is 11 years, forming a subset that has not undergone evaluation in the aforementioned studies. Because of this deficiency in research, the progress of PI in this group cannot be predicted by available data.…”

Section: Discussionmentioning

confidence: 99%

Fresh Autologous Pericardium to Reconstruct the Pulmonary Valve at the Annulus When Tetralogy of Fallot Requires a Transannular Patch at Midterm

Pande¹,

Sharma²,

Siddartha³

et al. 2016

Texas Heart Institute Journal

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Tetralogy of Fallot often requires reconstruction of the right ventricular outflow tract with a transannular patch (TAP), but this renders the pulmonary valve incompetent and eventually leads to right ventricular dysfunction.We P ulmonary insufficiency (PI) is an unwarranted side effect of the transannular patch (TAP) used for relieving the right ventricular outflow tract (RVOT) obstruction that is characteristic of tetralogy of Fallot (TOF).1 With time, the presence of PI causes right ventricular (RV) overload and eventually leads to RV dysfunction.2 Attempts to reduce insufficiency at the pulmonary valve (PV)-such as limiting the extent of infundibular incision or using a smaller transannular patch-have met with limited success.3,4 A TAP for RVOT reconstruction relieves its obstruction; but its expansion, especially at the level of the PV, cannot be governed, and this results in free pulmonary regurgitation. The use of a smaller TAP not only fails to relieve the RVOT obstruction efficiently but is unable to curtail the free PI. A procedure that can resolve the problem of PI with relief of RVOT obstruction must fulfill these 2 criteria: 1) limit the expanse of the TAP at the level of the native PV, while enabling it to bulge (and thereby increase the room in the RVOT to relieve obstruction) and 2) provide a competent PV. This study evaluates the efficiency of one such procedure at creating a competent PV complex (that is, a competent PV and a new pulmonary annulus) in TOF patients who need a TAP for relief of RVOT obstruction when undergoing complete intracardiac repair. This procedure was tested at midterm follow-up. Patients and MethodsThis is a retrospective analysis of 70 cases of children who underwent total cardiac repair for TOF

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Early and late outcomes of total repair of tetralogy of Fallot: risk factors for late right ventricular dilatation

Cited by 49 publications

References 22 publications

Surgery for Tetralogy of Fallot in Adults: Early Outcomes

Surgery for Tetralogy of Fallot in Adults: Early Outcomes

Predictors of ventricular tachyarrhythmia occurring late after intracardiac repair of tetralogy of Fallot: combination of QRS duration change rate and tricuspid regurgitation pressure gradient

Fresh Autologous Pericardium to Reconstruct the Pulmonary Valve at the Annulus When Tetralogy of Fallot Requires a Transannular Patch at Midterm

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