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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...

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Autores principales: Ono, Yoshikazu, Hoashi, Takaya, Imai, Kenta, Okuda, Naoki, Komori, Motoki, Kurosaki, Kenichi, Ichikawa, Hajime
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2022
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.
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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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