Massimo A Padalino1, Giacomo Cavalli2, Sonia B Albanese3, Carlo Pace Napoleone4, Alvise Guariento1, Maria Teresa Cascarano4, Martina Perazzolo Marra2, Vladimiro Vida1, Giovanna Boccuzzo5, Giovanni Stellin1. 1. Section of Pediatric and Congenital Cardiovascular Surgery, Department of Cardiac, Thoracic and Vascular Sciences, University of Padova Medical Italy, Padova, Italy. 2. Section of Cardiology, Department of Cardiac, Thoracic and Vascular Sciences, University of Padua, Padua, Italy. 3. Unit of Cardiac Surgery, Department of Cardiology and Cardiac Surgery, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy. 4. Division of Pediatric Cardiac Surgery, Ospedale Infantile Regina Margherita, Turin, Italy. 5. Department of Statistics, University of Padova, Padova, Italy.
Abstract
BACKGROUND AND AIM OF THE STUDY: Outcomes after repair of tetralogy of Fallot (TOF) are good with either a transventricular (TV) or transatrial (TA) approach. We sought to determine if there is a relationship between the TV or TA approach and right ventricular (RV) function, and the role of residual pulmonary regurgitation (PR) on the long-term outcomes. METHODS: This was a retrospective cohort multicentric study on survivors after surgical repair of TOF (TA versus TV approach, ±transannular patch) between 1990 and 2004. All patients underwent magnetic resonance imaging to assess RV volume, function, and PR. Patients were matched for length of follow-up and age. Clinical adverse events were retrieved from institutional databases. RESULTS: Seventy-nine patients (TA/TV = 37/42, median age 0.3 and 1.0 yrs, respectively) were included. At a median follow-up of 16.6 years (12.5-20.3), there were no differences in freedom from reintervention (either catheter or surgical), RV volumes, function, and PR between the TA and TV groups. Pulmonary valve (PV) replacement was significantly less frequent in the TA subgroup (P = 0.033) and patients with a preserved PV showed significantly lower RV volumes and less adverse events at follow-up. CONCLUSIONS: There is no significant difference in RV volumes and function between the TA and TV. However, the TA approach seems to be protective against PV replacement in the long-term. When PV is not preserved at repair, residual pulmonary regurgitation is a significant cause of late RV dysfunction and dilation, and is associated with a higher rate of late adverse events.
BACKGROUND AND AIM OF THE STUDY: Outcomes after repair of tetralogy of Fallot (TOF) are good with either a transventricular (TV) or transatrial (TA) approach. We sought to determine if there is a relationship between the TV or TA approach and right ventricular (RV) function, and the role of residual pulmonary regurgitation (PR) on the long-term outcomes. METHODS: This was a retrospective cohort multicentric study on survivors after surgical repair of TOF (TA versus TV approach, ±transannular patch) between 1990 and 2004. All patients underwent magnetic resonance imaging to assess RV volume, function, and PR. Patients were matched for length of follow-up and age. Clinical adverse events were retrieved from institutional databases. RESULTS: Seventy-nine patients (TA/TV = 37/42, median age 0.3 and 1.0 yrs, respectively) were included. At a median follow-up of 16.6 years (12.5-20.3), there were no differences in freedom from reintervention (either catheter or surgical), RV volumes, function, and PR between the TA and TV groups. Pulmonary valve (PV) replacement was significantly less frequent in the TA subgroup (P = 0.033) and patients with a preserved PV showed significantly lower RV volumes and less adverse events at follow-up. CONCLUSIONS: There is no significant difference in RV volumes and function between the TA and TV. However, the TA approach seems to be protective against PV replacement in the long-term. When PV is not preserved at repair, residual pulmonary regurgitation is a significant cause of late RV dysfunction and dilation, and is associated with a higher rate of late adverse events.
Authors: Benedetta Leonardi; Camilla Calvieri; Marco Alfonso Perrone; Arianna Di Rocco; Adriano Carotti; Massimo Caputo; Aurelio Secinaro; Davide Curione; Maria Giulia Gagliardi; Paolo Guccione; Sonia Albanese; Lorenzo Galletti; Fabrizio Drago Journal: Int J Environ Res Public Health Date: 2021-10-08 Impact factor: 3.390