Right ventricular outflow tract reintervention after primary tetralogy of Fallot repair in neonates and young infants

Balasubramanya, Shyamasundar; Zurakowski, David; Borisuk, Michele; Kaza, Aditya K.; Emani, Sitaram M.; Nido, Pedro J. del; Baird, Christopher W.

doi:10.1016/j.jtcvs.2017.09.019

Cited by 26 publications

(10 citation statements)

References 26 publications

(22 reference statements)

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“…The characteristics of these 15 eligible studies are summarized in Table 1 [1,3,4,5,6,7,8,9,10,11,12,13,14,15,16]. They include clinical outcomes from a diverse patient population from different continents spanning a time frame from 1997 to 2016.…”

Section: Resultsmentioning

confidence: 99%

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: Resultsmentioning

confidence: 99%

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

et al. 2019

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“…In comparison to the group with BT shunt palliation, the RVOT stent group had a shorter time to surgical repair (232 days vs 428 days), lower intensive care admission rate (22% vs 100%) and shorter length of stay (median 7 days vs 14 days) . Older patients with repaired TOF may also present with residual RVOT stenosis amenable to catheter balloon dilation and possibly stent implantation . Balloon dilation of conduit stenosis with or without transcatheter pulmonary valve replacement may delay the need for surgical conduit replacement …”

Section: Rvot Stenting In Patients With Tofmentioning

confidence: 99%

“…52 Older patients with repaired TOF may also present with residual RVOT stenosis amenable to catheter balloon dilation and possibly stent implantation. 53 The first attempt at transcatheter pulmonary valvotomy in PA/ IVS was described by Qureshi in 1990, with a success rate at shortterm follow-up in four of the five cases. Almost 30 years later, this procedure still carries a high risk.…”

mentioning

confidence: 99%

Anesthesia for high‐risk procedures in the catheterization laboratory

Daaboul

DiNardo

Nasr

2019

Pediatric Anesthesia

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Summary Recent advances in catheterization and imaging technology allow for more complex procedures to be performed in the catheterization laboratory. A number of lesions are now amenable to a percutaneous procedure, eliminating or at least postponing the need for a surgical intervention. Due to the increase in the complexity of the procedures performed, the involvement of anesthesiologists and their close collaboration with the interventional cardiologists have increased. It is important to understand the physiology and pathophysiology of the patients and to anticipate the plans and the potential complications in order to manage them. We are witnessing a rise in the number of complex interventions in newborns and infants, such as balloon valvotomy (critical aortic stenosis, pulmonary stenosis), radio frequency perforation (of pulmonary atresia and intact ventricular septum), right ventricular outflow tract stenting (in Tetralogy of Fallot), ductal stenting (in some ductus‐dependent pulmonary circulation), and combined with a surgical procedure (hybrid procedure for hypoplastic left heart syndrome). Multiple registries have been created in order to understand and improve outcomes of patients with congenital heart disease undergoing catheterization procedures and to develop performance and quality metrics, from which data regarding anesthetic‐related risks can be extrapolated. Experienced personnel and a multidisciplinary team approach with direct communication among the team members is a must to ensure anticipation and management of critical events when they occur.

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“…In this issue of the Journal, Balasubramanya and colleagues 1 from Boston Children's Hospital share a rich experience of primary tetralogy of Fallot (TOF) repair in neonates and young infants during a period of 10 years. Although there may still be debate regarding the merits of primary repair for TOF versus staged repair, the improvement in cardiopulmonary bypass techniques has certainly lent weight to the argument for early primary repair.…”

Section: Ibrahim Abdullah MDmentioning

confidence: 99%

The case for a pulmonary valve in neonatal and young infant primary tetralogy of Fallot repair: Does it make a difference?

Abdullah

2018

The Journal of Thoracic and Cardiovascular Surgery

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Right ventricular outflow tract reintervention after primary tetralogy of Fallot repair in neonates and young infants

Cited by 26 publications

References 26 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 †

Anesthesia for high‐risk procedures in the catheterization laboratory

The case for a pulmonary valve in neonatal and young infant primary tetralogy of Fallot repair: Does it make a difference?

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