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Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure
OBJECTIVES: The study objectives were to reconfirm the superiority of the pulmonary valve-sparing procedure versus the transannular patch procedure for repair of tetralogy of Fallot and to evaluate the influence of a right ventriculotomy in the pulmonary valve-sparing procedure. METHODS: Between 197...
Autores principales: | , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390402/ https://www.ncbi.nlm.nih.gov/pubmed/36003424 http://dx.doi.org/10.1016/j.xjon.2021.10.061 |
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author | Ono, Yoshikazu Hoashi, Takaya Imai, Kenta Okuda, Naoki Komori, Motoki Kurosaki, Kenichi Ichikawa, Hajime |
author_facet | Ono, Yoshikazu Hoashi, Takaya Imai, Kenta Okuda, Naoki Komori, Motoki Kurosaki, Kenichi Ichikawa, Hajime |
author_sort | Ono, Yoshikazu |
collection | PubMed |
description | OBJECTIVES: The study objectives were to reconfirm the superiority of the pulmonary valve-sparing procedure versus the transannular patch procedure for repair of tetralogy of Fallot and to evaluate the influence of a right ventriculotomy in the pulmonary valve-sparing procedure. METHODS: Between 1978 and 2003, 440 patients (aged <10 years) underwent tetralogy of Fallot repair. Of these patients, 242 (55.0%) underwent the transannular patch procedure, 106 (24.1%) underwent the pulmonary valve-sparing procedure without right ventriculotomy, and 92 (20.9%) underwent the pulmonary valve-sparing procedure with right ventriculotomy. End points focused on adverse events and included all-cause mortality, reoperation, catheter intervention, and symptomatic arrhythmias. To compare the outcomes of pulmonary valve sparing with and without right ventriculotomy, inverse probability weighting was applied to adjust for potential confounding factors. RESULTS: The median follow-up period was 20.3 years (interquartile range, 10.7-27.6). In all cohorts, the pulmonary valve-sparing procedure was the independent factor that reduced adverse events after tetralogy of Fallot repair (hazard ratio, 0.47; 95% confidence interval, 0.23-0.94; P = .033). After weighting, there was no difference in overall survival or event-free survival in the pulmonary valve-sparing with and without right ventriculotomy group. However, the pulmonary valve-sparing with right ventriculotomy group exhibited a larger cardiothoracic ratio (beta: 6.01; 95% confidence interval, 2.36-9.66; P = .001), lower medication-free rate (odds ratio, 0.29; 95% confidence interval, 0.098-0.79; P = .019), and higher New York Heart Association functional classification (odds ratio, 2.99; 95% confidence interval, 1.36-6.80; P = .007) at the latest follow-up. CONCLUSIONS: Right ventriculotomy for tetralogy of Fallot repair with pulmonary valve-sparing did not increase major adverse events. However, negative impacts on current status cannot be ignored. |
format | Online Article Text |
id | pubmed-9390402 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-93904022022-08-23 Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure Ono, Yoshikazu Hoashi, Takaya Imai, Kenta Okuda, Naoki Komori, Motoki Kurosaki, Kenichi Ichikawa, Hajime JTCVS Open Congenital: Tetralogy of Fallot OBJECTIVES: The study objectives were to reconfirm the superiority of the pulmonary valve-sparing procedure versus the transannular patch procedure for repair of tetralogy of Fallot and to evaluate the influence of a right ventriculotomy in the pulmonary valve-sparing procedure. METHODS: Between 1978 and 2003, 440 patients (aged <10 years) underwent tetralogy of Fallot repair. Of these patients, 242 (55.0%) underwent the transannular patch procedure, 106 (24.1%) underwent the pulmonary valve-sparing procedure without right ventriculotomy, and 92 (20.9%) underwent the pulmonary valve-sparing procedure with right ventriculotomy. End points focused on adverse events and included all-cause mortality, reoperation, catheter intervention, and symptomatic arrhythmias. To compare the outcomes of pulmonary valve sparing with and without right ventriculotomy, inverse probability weighting was applied to adjust for potential confounding factors. RESULTS: The median follow-up period was 20.3 years (interquartile range, 10.7-27.6). In all cohorts, the pulmonary valve-sparing procedure was the independent factor that reduced adverse events after tetralogy of Fallot repair (hazard ratio, 0.47; 95% confidence interval, 0.23-0.94; P = .033). After weighting, there was no difference in overall survival or event-free survival in the pulmonary valve-sparing with and without right ventriculotomy group. However, the pulmonary valve-sparing with right ventriculotomy group exhibited a larger cardiothoracic ratio (beta: 6.01; 95% confidence interval, 2.36-9.66; P = .001), lower medication-free rate (odds ratio, 0.29; 95% confidence interval, 0.098-0.79; P = .019), and higher New York Heart Association functional classification (odds ratio, 2.99; 95% confidence interval, 1.36-6.80; P = .007) at the latest follow-up. CONCLUSIONS: Right ventriculotomy for tetralogy of Fallot repair with pulmonary valve-sparing did not increase major adverse events. However, negative impacts on current status cannot be ignored. Elsevier 2022-01-22 /pmc/articles/PMC9390402/ /pubmed/36003424 http://dx.doi.org/10.1016/j.xjon.2021.10.061 Text en © 2022 The Author(s) https://creativecommons.org/licenses/by/4.0/This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Congenital: Tetralogy of Fallot Ono, Yoshikazu Hoashi, Takaya Imai, Kenta Okuda, Naoki Komori, Motoki Kurosaki, Kenichi Ichikawa, Hajime Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure |
title | Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure |
title_full | Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure |
title_fullStr | Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure |
title_full_unstemmed | Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure |
title_short | Impact of right ventriculotomy for tetralogy of Fallot repair with a pulmonary valve–sparing procedure |
title_sort | impact of right ventriculotomy for tetralogy of fallot repair with a pulmonary valve–sparing procedure |
topic | Congenital: Tetralogy of Fallot |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9390402/ https://www.ncbi.nlm.nih.gov/pubmed/36003424 http://dx.doi.org/10.1016/j.xjon.2021.10.061 |
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