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Preserving the pulmonary valve in Tetralogy of Fallot repair: Reconsidering the indication for valve‐sparing
BACKGROUND: Tetralogy of Fallot (TOF) repair is a frequent procedure, and although valve‐sparing (VS) repair is preferred, determining which patients can successfully undergo this operation remains controversial. We sought to identify parameters to determine a selective, accurate indication for VS r...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10100041/ https://www.ncbi.nlm.nih.gov/pubmed/36378940 http://dx.doi.org/10.1111/jocs.17156 |
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author | Siddiqi, Umar Adewale, Adedotun Pena, Emily Schulz, Kelci Ilbawi, Michel El‐Zein, Chawki Vricella, Luca Hibino, Narutoshi |
author_facet | Siddiqi, Umar Adewale, Adedotun Pena, Emily Schulz, Kelci Ilbawi, Michel El‐Zein, Chawki Vricella, Luca Hibino, Narutoshi |
author_sort | Siddiqi, Umar |
collection | PubMed |
description | BACKGROUND: Tetralogy of Fallot (TOF) repair is a frequent procedure, and although valve‐sparing (VS) repair is preferred, determining which patients can successfully undergo this operation remains controversial. We sought to identify parameters to determine a selective, accurate indication for VS repair. METHODS: We reviewed 71 patients (82%) undergoing VS repair. We analyzed hemodynamic data, intraoperative reports, and follow‐up echocardiography results to identify acceptable indications. Patients requiring pulmonary valve (PV) reintervention versus no reintervention were compared. RESULTS: PV annulus size at repair was z‐score of −2.0 (−5.3, 1.3). Approximately half (51%) had a z‐score less than −2. Cox regression results showed this was not a risk factor for reintervention (p = .59). Overall, 1‐, 3‐, 5‐, and 10‐year freedom from PV reintervention rates were 95.8%, 92.8%, 91% and 77.8%, respectively. Residual pulmonary stenosis (PS) at initial repair was relatively higher in the reintervention group compared with no reintervention group (40 [28, 51] mmHg vs. 30 [22, 37] mmHg; p = .08). For patients with residual PS, pressure gradient (PG) was consistent over time across both groups (PV reintervention: −3 [−15, 8] mmHg vs. no reintervention: 0 [−9, 8] mmHg). The risk of PV reintervention is 3.7‐fold higher when the PG from intraoperative TEE is greater than 45 mmHg (p = .04). CONCLUSIONS: Our review of the midterm outcomes of expanded indication for VS suggests intraoperative decision to convert to transannular patch is warranted if intraoperative postprocedure TEE PG is greater than 45 mmHg or RV pressure is higher than half of systemic pressure to prevent reintervention. |
format | Online Article Text |
id | pubmed-10100041 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-101000412023-04-14 Preserving the pulmonary valve in Tetralogy of Fallot repair: Reconsidering the indication for valve‐sparing Siddiqi, Umar Adewale, Adedotun Pena, Emily Schulz, Kelci Ilbawi, Michel El‐Zein, Chawki Vricella, Luca Hibino, Narutoshi J Card Surg Regular Issue Papers BACKGROUND: Tetralogy of Fallot (TOF) repair is a frequent procedure, and although valve‐sparing (VS) repair is preferred, determining which patients can successfully undergo this operation remains controversial. We sought to identify parameters to determine a selective, accurate indication for VS repair. METHODS: We reviewed 71 patients (82%) undergoing VS repair. We analyzed hemodynamic data, intraoperative reports, and follow‐up echocardiography results to identify acceptable indications. Patients requiring pulmonary valve (PV) reintervention versus no reintervention were compared. RESULTS: PV annulus size at repair was z‐score of −2.0 (−5.3, 1.3). Approximately half (51%) had a z‐score less than −2. Cox regression results showed this was not a risk factor for reintervention (p = .59). Overall, 1‐, 3‐, 5‐, and 10‐year freedom from PV reintervention rates were 95.8%, 92.8%, 91% and 77.8%, respectively. Residual pulmonary stenosis (PS) at initial repair was relatively higher in the reintervention group compared with no reintervention group (40 [28, 51] mmHg vs. 30 [22, 37] mmHg; p = .08). For patients with residual PS, pressure gradient (PG) was consistent over time across both groups (PV reintervention: −3 [−15, 8] mmHg vs. no reintervention: 0 [−9, 8] mmHg). The risk of PV reintervention is 3.7‐fold higher when the PG from intraoperative TEE is greater than 45 mmHg (p = .04). CONCLUSIONS: Our review of the midterm outcomes of expanded indication for VS suggests intraoperative decision to convert to transannular patch is warranted if intraoperative postprocedure TEE PG is greater than 45 mmHg or RV pressure is higher than half of systemic pressure to prevent reintervention. John Wiley and Sons Inc. 2022-11-15 2022-12 /pmc/articles/PMC10100041/ /pubmed/36378940 http://dx.doi.org/10.1111/jocs.17156 Text en © 2022 The Authors. Journal of Cardiac Surgery published by Wiley Periodicals LLC. https://creativecommons.org/licenses/by/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by/4.0/ (https://creativecommons.org/licenses/by/4.0/) License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited. |
spellingShingle | Regular Issue Papers Siddiqi, Umar Adewale, Adedotun Pena, Emily Schulz, Kelci Ilbawi, Michel El‐Zein, Chawki Vricella, Luca Hibino, Narutoshi Preserving the pulmonary valve in Tetralogy of Fallot repair: Reconsidering the indication for valve‐sparing |
title | Preserving the pulmonary valve in Tetralogy of Fallot repair: Reconsidering the indication for valve‐sparing |
title_full | Preserving the pulmonary valve in Tetralogy of Fallot repair: Reconsidering the indication for valve‐sparing |
title_fullStr | Preserving the pulmonary valve in Tetralogy of Fallot repair: Reconsidering the indication for valve‐sparing |
title_full_unstemmed | Preserving the pulmonary valve in Tetralogy of Fallot repair: Reconsidering the indication for valve‐sparing |
title_short | Preserving the pulmonary valve in Tetralogy of Fallot repair: Reconsidering the indication for valve‐sparing |
title_sort | preserving the pulmonary valve in tetralogy of fallot repair: reconsidering the indication for valve‐sparing |
topic | Regular Issue Papers |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10100041/ https://www.ncbi.nlm.nih.gov/pubmed/36378940 http://dx.doi.org/10.1111/jocs.17156 |
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