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

Awori, Mark Nelson; Mehta, Nikita; Mitema, Frederick O.; Kebba, Naomi

doi:10.1177/2150135118757991

Cited by 13 publications

(13 citation statements)

References 31 publications

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“…Moreover, a “cut-off” PV Z -score value to delineate between the two surgical approaches has not been well established, with conflicting available literature. Some groups such as Awori et al support a PV Z -score of −2 as a marker below which to insert a TAP [2]. In contrast, Stewart et al observed that a PV Z -score greater than −4 was found to be a predictor of pulmonary valve preservation with minimal recurrent obstruction ( n = 85) [3].…”

Section: Discussionmentioning

confidence: 99%

“…However, there are several controversies surrounding this approach, such as the ideal age and weight for complete repair, staged versus primary repair, the role of percutaneous interventions in staging, and the importance of sparing the RV infundibulum. PV annulus Z -score correlates, derived from preoperative transthoracic echocardiography measurements, have played a vital role in this decision-making process, and a score below −2 has been commonly referenced as a “cut-off” point for the insertion of a TAP [2]. Therefore, the aim of this study was to conduct a review of current literature to help identify practice patterns of VSS for ToF repair based on preoperative PV Z -scores, and analyze outcomes with respect to the incidence of subsequent re-intervention/reoperation for residual RVOT obstruction.…”

Section: Introductionmentioning

confidence: 99%

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Validity of Pulmonary Valve Z-Scores in Predicting Valve-Sparing Tetralogy Repairs—Systematic Review †

et al. 2019

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There is a lack of consensus regarding the preoperative pulmonary valve (PV) Z-score “cut-off” in tetralogy of Fallot (ToF) patients to attempt a successful valve sparing surgery (VSS). Therefore, the aim of this study was to review the available evidence regarding the association between preoperative PV Z-score and rate of re-intervention for residual right ventricular outflow tract (RVOT) obstruction, i.e. successful valve sparing surgery. A systematic search of studies reporting outcomes of VSS for ToF was performed utilizing PubMed, EMBASE, and Scopus databases. Patients with ToF variants such as pulmonary atresia, major aortopulmonary collaterals, absent pulmonary valve, associated atrioventricular septal defect, and discontinuous pulmonary arteries were excluded. Out of 712 screened publications, 15 studies met inclusion criteria. A total of 1091 patients had surgery at a median age and weight of 6.9 months and 7.2 kg, respectively. VSS was performed on the basis of intraoperative PV assessment in 14 out of 15 studies. The median preoperative PV Z-score was −1.7 (0 to −4.9) with a median re-intervention rate of 4.7% (0–36.8%) during a median follow-up of 2.83 years (1.4–15.8 years). Quantitatively, there was no correlation between decreasing preoperative PV Z-scores and increasing RVOT re-intervention rates with a correlation coefficient of −0.03 and an associated p-value of 0.91. In observational studies, VSS for ToF repair was based on intraoperative evaluation and sizing of the PV following complete relief of all levels of obstruction of the RVOT, rather than pre-operative echocardiography derived PV Z-scores.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Validity of Pulmonary Valve Z-Scores in Predicting Valve-Sparing Tetralogy Repairs—Systematic Review †

et al. 2019

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“…Some publications demonstrated that optimal z‐score value for TAP was <−2, 17‐19 whereas Bono and Stewart et al 20,21 set an ideal z‐score of <−4. A meta‐analysis suggested that the “cutoff” value should be set at −2 when used the Pettersen's dataset 22 . In 2012, Awori et al 23 reported the unacceptable gradient across the PVA in relation to PVA size and recommended TAP insertion when zPVA is less than −1.3.…”

Section: Discussionmentioning

confidence: 99%

“…A meta-analysis suggested that the "cutoff" value should be set at −2 when used the Pettersen's dataset. 22 In 2012, Awori et al 23 Furthermore, their study found that the z-scores derived from different datasets may have contributed to the wide dispersion in the "cutoff" PVA z-score values. The zPVA was used to normalize the PVA diameter because of heart growth throughout child development.…”

Section: Optimal "Cutoff" Value For Tapmentioning

confidence: 99%

Pulmonary valve annular and right ventricular outflow tract size as predictions values for moderate to severe pulmonary regurgitation after repaired Tetralogy of Fallot

Ding

Jin

et al. 2020

Echocardiography

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Tetralogy of Fallot (TOF) is one of the most common congenital heart diseases with an approximate incidence of 3 per every 10 000 neonates. It accounts for 60%-80% of all cyanotic congenital heart diseases. 1 The first successful intracardiac repair of TOF was carried out by Lillehei in 1954. Total corrective repair for TOF consisted of ventricular septal defect closure and relief of right ventricular outflow tract obstruction (RVOTO). Over the past few decades, the early results of surgical repair of TOF were thought to be excellent; however, there has been some mid-term to long-term complications like pulmonary incompetence, right ventricular dilation, residual RVOTO, aortic dilation, and arrhythmia, 2-8 which increase the early and late reinterventions.

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“…This strategy has been associated with favourable outcomes when the pulmonary valve annulus is well developed 6,7 but could result in significant residual pulmonary stenosis in patients with an underdeveloped valve. [8][9][10] There have been studies on the short-term effect of both surgical strategies, but the long-term impact of their associated residual lesions remains elusive.…”

Section: Knowledge Gaps In Tofmentioning

confidence: 99%

The TRIVIA Cohort for Surgical Management of Tetralogy of Fallot: Merging Population and Clinical Data for Real-World Scientific Evidence

et al. 2020

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Background Guidelines for surgical management of tetralogy of Fallot (TOF) are often based on low-quality evidence due to the many challenges of congenital heart disease: heterogeneous cardiac anatomy, consequences from surgical interventions arising years later, and scarcity of hard outcomes. The overarching goal of the T etralogy of Fallot R esearch for I mprovement of V alve replacement I ntervention: A Bridge Across the Knowledge Gap (TRIVIA) study is to evaluate the long-term impact of the surgical management strategies in TOF. The specific objectives are: (1) to describe the long-term outcomes of TOF according to the native anatomy and the presence of genetic conditions, (2) to evaluate the long-term outcomes of surgical repair according to associated residual lesions, and (3) to evaluate the impact of paediatric pulmonary valve replacements on the long-term outcomes. Methods The TRIVIA study is a population-based cohort including all subjects with TOF in the province of Québec between 1980 and 2017. It links patient-level granular clinical data with long-term administrative health care data. We will evaluate mortality, cardiovascular interventions, and hospitalizations for adverse cardiovascular events using survival Cox models and marginal mean/rates models for recurrent events, respectively. Multivariate multilevel models will correct for potential confounders, and risk score matching will mitigate the potential of confounding by indication. Results The current TRIVIA cohort includes 1001 eligible subjects with TOF with complete lifelong follow-up for > 98%. The median follow-up is 17.1 years, totalling > 17,000 patient-years. Conclusions Universal health insurance data combined with granular clinical data enable the development of population-based cohorts, to which contemporary statistical methods are applied to address important research questions in congenital heart disease research.

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

Cited by 13 publications

References 31 publications

Validity of Pulmonary Valve Z-Scores in Predicting Valve-Sparing Tetralogy Repairs—Systematic Review †

Validity of Pulmonary Valve Z-Scores in Predicting Valve-Sparing Tetralogy Repairs—Systematic Review †

Pulmonary valve annular and right ventricular outflow tract size as predictions values for moderate to severe pulmonary regurgitation after repaired Tetralogy of Fallot

The TRIVIA Cohort for Surgical Management of Tetralogy of Fallot: Merging Population and Clinical Data for Real-World Scientific Evidence

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