Pulmonary cusp augmentation in repair of tetralogy of Fallot

Attanawanich, Sukasom; Ngodgnamthaweesuk, Montein; Kitjanon, Narumol; Sitthisombat, Chanawit

doi:10.1177/0218492312444284

Cited by 12 publications

(7 citation statements)

References 17 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One noteworthy limitation in our meta-analysis was that materials of the monocusp were not brought into study. For all included studies, 3 declared that they used autologous pericardium to form monocusp, [ 13 , 16 , 17 ] another 3 used monocusp of polytetrafluoroethylene (PTFE) [ 18 – 20 ], other studies used more than one type of material or did not explain specific material of monocusp. Besides, we have noticed that 1 of the included studies has compared outcomes between TAP with autologous pericardium monocusp and PTFE monocusp, which showed no significant difference in outcomes at 3-year follow-up [ 14 ].…”

Section: Discussionmentioning

confidence: 99%

Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction: a meta-analysis

Wei

et al. 2022

BMC Surg

View full text Add to dashboard Cite

Background Tetralogy of Fallot (TOF) is one of the most common cyanotic congenital heart diseases. Pulmonary regurgitation is the most common and severe comorbidity after transannular patch (TAP) repair of TOF patients. It has not been confirmed whether a TAP repair with monocusp valve reconstruction would benefit TOF patients in perioperative period compared to those without monocusp valve reconstruction. The purpose of the study is to review and analyze all clinical studies that have compared perioperative outcomes of TOF patients undergoing TAP repair with or without monocusp valve reconstruction and conduct a preferable surgery. Methods Eligible studies were identified by searching the electronic databases. The year of publication of studies was restricted from 2000 till present. The primary outcome was perioperative mortality, and secondary outcomes included cardiopulmonary bypass time, aortic cross-clamp time, ventilation duration, ICU length of stay, hospital length of stay, perioperative right ventricular outflow tract (RVOT) pressure gradient, and moderate or severe pulmonary regurgitation (PR). The meta-analysis and forest plots were drawn using Review Manager 5.3. Statistically significant was considered when p-value ≤ 0.05. Results Eight studies were included which consisted of 8 retrospective cohort study and 2 randomized controlled trial. The 10 studies formed a pool of 526 TOF patients in total, in which are 300 undergoing TAP repair with monocusp valve reconstruction (monocusp group) compared to 226 undergoing TAP repair without monocusp valve reconstruction (non-monocusp group). It demonstrated no significant differences between two groups in perioperative mortality (OR = 0.69, 95% CI 0.20–2.41, p = 0.58). It demonstrated significant differences in perioperative cardiopulmonary bypass time (minute, 95% CI 17.93–28.42, p < 0.00001), mean length of ICU stay (day, 95% CI − 2.11–0.76, p < 0.0001), and the degree of perioperative PR (OR = 0.03, 95% CI 0.010.12, p < 0.00001). Significant differences were not found in other secondary outcomes. Conclusion Transannular patch repair with monocusp valve reconstruction have significant advantages on decreasing length of ICU stay and reducing degree of PR for TOF patients. Large, multicenter, randomized, prospective studies which focuse on perioperative outcomes and postoperative differences based on long-term follow-up between TAP repair with and without monocusp valve reconstruction are needed.

show abstract

Section: Discussionmentioning

confidence: 99%

Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction: a meta-analysis

Wei

et al. 2022

BMC Surg

View full text Add to dashboard Cite

show abstract

“…In this regard, the creation of a monocusp valve does restore competence in the early postoperative period. 3 Some techniques of monocusp creation significantly prolong cardiopulmonary bypass time. 3 Longer cardiopulmonary bypass times have been associated with poorer operative outcomes.…”

Section: Commentmentioning

confidence: 99%

“…3 Some techniques of monocusp creation significantly prolong cardiopulmonary bypass time. 3 Longer cardiopulmonary bypass times have been associated with poorer operative outcomes. 20 Any procedure that prolongs the cardiopulmonary bypass time unnecessarily should be avoided.…”

Section: Commentmentioning

confidence: 99%

“…2 There is evidence that the creation of a monocusp valve restores pulmonary valve competence in the early postoperative period. 3 It has been reported that this may reduce operative morbidity and mortality 2 ; however, there are also reports that monocusp valves do not reduce operative mortality or morbidity. 4 A meta-analysis of randomized clinical trials (RCTs) is considered the highest form of evidence used to guide patient care.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Monocusp Valves Do Not Improve Early Operative Mortality in Tetralogy of Fallot: A Meta-Analysis

Awori

Mehta

et al. 2020

World J Pediatr Congenit Heart Surg

View full text Add to dashboard Cite

Monocusp valves are thought to reduce early operative mortality and morbidity associated with pediatric tetralogy of Fallot repair. As there are no published randomized clinical trials comparing outcomes with and without a monocusp valve, we performed a meta-analysis of observational studies in accordance with established protocols. After systematically searching PubMed, the Cochrane Library, and Google Scholar, 12 studies were included. The operative mortality was compared in 695 patients, and we found no difference between patients with and patients without a monocusp valve. Monocusp valves may not improve operative mortality of tetralogy of Fallot repair in pediatric patients.

show abstract

“…The combination of ventriculotomy and free pulmonary regurgitation leads to progressive deterioration of right ventricular function and the onset of arrhythmias [ 3 ]. To preserve pulmonary valve competence, various materials have been used in manufacturing neovalves including autologous pericardium, bovine pericardium, polytetrafluoroethylene and valved conduits [ 15 , 16 ]. However, the biological nature of these materials predisposes them to future tissue degeneration, calcification and dysfunction, with the potential development of stenosis-insufficiency, leading to the need for multiple interventions [ 17 ].…”

Section: Introductionmentioning

confidence: 99%

Repair with a pulmonary neovalve in tetralogy of Fallot: does this avoid ventricular dysfunction?

Guerrero

Pineda-Rodríguez

Palacio

et al. 2022

Interactive CardioVascular and Thoracic Surgery

View full text Add to dashboard Cite

Introduction Given the anatomical variations of tetralogy of Fallot (TOF), different surgical techniques can be used to achieve correction. Transannular patches are the most commonly used technique; they are associated with right ventricular dysfunction, the incidence of which can be reduced through pulmonary valve preservation. Methods Between January 2010 and July 2019, we performed 274 surgical corrections of TOF at Fundación Cardioinfantil; 63 patients (23%) underwent repair with a transannular patch in addition to a pulmonary neovalve (Group I), 66 patients (24.1%) received a transannular patch without a pulmonary valve (Group II) and 145 patients (52.9%) had a repair with valve preservation (Group III). We analyzed patient’s characteristics before, during and after surgery at a 30-day follow-up. Results We found that patients in Group III were older (p = 0.04). Group II had the lowest level of O2 saturation before surgery (82%, p = 0.001). Cardiopulmonary bypass (CPB) and aortic cross-clamp times were longer in Group I (p < 0.001). Right ventricular dysfunction was less frequent in Group III (15.9%, p = 0.011). Severe residual pulmonary regurgitation was more common in Group II (21.9%, p = 0.001). Conclusions Preservation of the pulmonary valve is an important factor for immediate postoperative management of TOF. Patients who were repaired with a transannular patch with or without a pulmonary neovalve had a higher incidence of right ventricular dysfunction than those with pulmonary valve preservation.

show abstract

Pulmonary cusp augmentation in repair of tetralogy of Fallot

Abstract: reconstruction of the native pulmonary valve accompanied by pulmonary cusp augmentation can reduce postoperative pulmonary insufficiency and has a more favorable long-term outcome.

Cited by 12 publications

References 17 publications

Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction: a meta-analysis

Transannular patch repair of tetralogy of Fallot with or without monocusp valve reconstruction: a meta-analysis

Monocusp Valves Do Not Improve Early Operative Mortality in Tetralogy of Fallot: A Meta-Analysis

Repair with a pulmonary neovalve in tetralogy of Fallot: does this avoid ventricular dysfunction?

Contact Info

Product

Resources

About