Right artial approach for surgical correction of tetralogy of fallot

Dietl, Charles A.; Torres, Alberto R.; Cazzaniga, M; Favaloro, René G.

doi:10.1016/0003-4975(89)90430-x

Cited by 14 publications

(6 citation statements)

References 25 publications

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“…After obtaining two comparable groups by propensity score matching, however, post-matched comparison showed that AP upon ToF repair is superior to TAP in lowering the risk of late postoperative PVI. Contemporary strategies for surgical management of ToF include early primary repair without palliation [6,12,20,23], minimal or no right ventriculotomy [13,18], transatrial VSD closure [7], and aggressive AP [1,16,19,21,25]. The optimal timing of ToF repair is now considered to be approximately 6 months of age [24], and earlier primary intervention, even if in the neonatal period, is encouraged if patients are symptomatic.…”

Section: Discussionmentioning

confidence: 99%

Pulmonary Annulus Preservation Lowers the Risk of Late Postoperative Pulmonary Valve Implantation After the Repair of Tetralogy of Fallot

2014

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The long-term benefits of pulmonary annulus preservation in tetralogy of Fallot (ToF) repair in patients with a marginally small pulmonary annulus are controversial. We sought to determine whether pulmonary annulus preservation (AP) is superior to transannular patching (TAP) in lowering the risk of pulmonary valve implantation (PVI) long after the repair of ToF. Of the 255 patients who underwent total correction of ToF during infancy between January 1989 and December 2005, 114 patients (AP group = 57, TAP group = 57) were selected by propensity score matching for various preoperative variables, such as age and body weight at operation, sex, pulmonary artery size, pre-repair palliation, anatomical types of ventricular septal defect, and Z-score of pulmonary valve annulus diameter (PVA-Z). The PVA-Z of the AP and TAP groups were -2.3 ± 1.3 and -2.1 ± 1.3, respectively (p = 0.547). The time to PVI was compared between the two groups. The median follow-up duration was 146 months (AP group: 141 months, TAP group: 147 months; p = 0.191). During the follow-up periods, there were 12 reoperations for the relief of right ventricular outflow tract obstruction (RVOTO), eight PVIs, and three late deaths. While freedom from reoperation for RVOTO was comparable between the two groups (p = 0.182), freedom from PVI at postoperative 15 years was significantly lower in the TAP group than in the AP group (74 and 100 %, p = 0.015). In repairing ToF with marginally small pulmonary valve annulus, AP is associated with a lower risk of late postoperative PVI.

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Section: Discussionmentioning

confidence: 99%

Pulmonary Annulus Preservation Lowers the Risk of Late Postoperative Pulmonary Valve Implantation After the Repair of Tetralogy of Fallot

2014

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“…The adequacy of this approach has been highlighted by other authors. 5 Other series dealing with this specific anatomic condition cite in-hospital mortality rates between 8% and 29%, 14,15,18 with an incidence of RV-PA conduit implantation as great as 40%. 14 The reference role of these publications should not be overestimated, however, because they belong to another era of cardiac surgery.…”

Section: Discussionmentioning

confidence: 99%

“…2 This technique has since been favored by some centers. [3][4][5][6][7] The functional benefits include a lower incidence of arrhythmia and lower incidence and severity of early and late postoperative dysfunction of the right ventricle (RV). [8][9][10][11][12] Objectives: The study's object was to analyze the outcomes of transatrialtranspulmonary repair in children with tetralogy of Fallot and anomalous coronary artery crossing the right ventricular outflow tract.…”

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confidence: 99%

“…One technical advantage of the transatrial-transpulmonary approach is the possibility of undertaking repair even when a major coronary artery branch crosses the infundibulum, precluding a conventional transventricular repair. 5,6 We have been using the transatrial-transpulmonary approach since 1980 for all tetralogy repairs. Among the 611 patients so operated on in our unit, 36 had an anomalous course of a coronary artery that would have precluded conventional transventricular repair.…”

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confidence: 99%

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Transatrial-transpulmonary tetralogy of fallot repair is effective in the presence of anomalous coronary arteries

Brizard

Mas

Sohn

et al. 1998

The Journal of Thoracic and Cardiovascular Surgery

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“…Percentage of patients (65%) of this series needed transannular patch is consistent with some series. 8,14,[16][17][18] Longer duration of mechanical ventilation, inotrope support, ICU stay & more morbidity in group B patients as it is seen other studies , 6,8,10,19 may be due to restricted right ventricular physiology which is more common after transannular patch. 20 Post operative morbidity of patients of this series are consistent with other series.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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

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Right artial approach for surgical correction of tetralogy of fallot

Cited by 14 publications

References 25 publications

Pulmonary Annulus Preservation Lowers the Risk of Late Postoperative Pulmonary Valve Implantation After the Repair of Tetralogy of Fallot

Pulmonary Annulus Preservation Lowers the Risk of Late Postoperative Pulmonary Valve Implantation After the Repair of Tetralogy of Fallot

Transatrial-transpulmonary tetralogy of fallot repair is effective in the presence of anomalous coronary arteries

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

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