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Pediatr Cardiol. 2016 Jun;37(5):818-25. doi: 10.1007/s00246-016-1355-1. Epub 2016 Feb 26.

Aiming to Preserve Pulmonary Valve Function in Tetralogy of Fallot Repair: Comparing a New Approach to Traditional Management.

Author information

1
Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.
2
Pediatric Cardiac Surgery, New Orleans Children's Hospital, New Orleans, LA, USA.
3
Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.
4
Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA.
5
Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA. eb2709@cumc.columbia.edu.

Abstract

Pulmonary valve (PV) incompetence following transannular patch (TAP) repair of tetralogy of Fallot (TOF) results in long-term morbidity and mortality. Valve-sparing repairs have recently gained recognition; however, they may be associated with residual pulmonary stenosis (PS) in patients with small PV z scores. We sought to determine whether a repair that increases the PV annulus and augments the valve leaflet with a biomaterial would result in annular growth and in longer duration of valve competence compared with TAP. Eighty patients (median age 136 days, range 4-350) who underwent surgical repair of TOF between 2010 and 2014 were included in the study. Patients were divided into three groups based on the PV intervention: balloon dilation/valvotomy (n = 29), valve-sparing transannular repair (VSTAR) (n = 19) and TAP (n = 32). Intraoperative, early postoperative and midterm follow-up echocardiographic data (median 19 months, range 1-59) were obtained. The primary outcomes were the presence and severity of pulmonary regurgitation and/or PS. Compared with TAP, VSTAR patients demonstrated significantly less severe PR with 100 % freedom of severe PR immediately post-op (vs. 0 % in TAP), 60 % at 6 months and 20 % at 20 months. There were no differences in PS between VSTAR and TAP at follow-up. A subgroup analysis of the VSTAR group was performed. PV z scores were calculated and fit to a random effects model. Patient data fit the model closely, predicting a reproducible increase in valve annulus size over time. With better short-term and comparable midterm results, VSTAR may be appropriate for TOF repair in patients with small PV that would conventionally require a TAP.

KEYWORDS:

Pulmonary valve; Tetralogy of Fallot; Transannular patch repair; Valve-sparing repair

PMID:
26921062
DOI:
10.1007/s00246-016-1355-1
[Indexed for MEDLINE]

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