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Pulmonary Annulus Preservation Lowers the Risk of Late Postoperative Pulmonary Valve Implantation After the Repair of Tetralogy of Fallot

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Abstract

The long-term benefits of pulmonary annulus preservation in tetralogy of Fallot (ToF) repair in patients with a marginally small pulmonary annulus are controversial. We sought to determine whether pulmonary annulus preservation (AP) is superior to transannular patching (TAP) in lowering the risk of pulmonary valve implantation (PVI) long after the repair of ToF. Of the 255 patients who underwent total correction of ToF during infancy between January 1989 and December 2005, 114 patients (AP group = 57, TAP group = 57) were selected by propensity score matching for various preoperative variables, such as age and body weight at operation, sex, pulmonary artery size, pre-repair palliation, anatomical types of ventricular septal defect, and Z-score of pulmonary valve annulus diameter (PVA-Z). The PVA-Z of the AP and TAP groups were −2.3 ± 1.3 and −2.1 ± 1.3, respectively (p = 0.547). The time to PVI was compared between the two groups. The median follow-up duration was 146 months (AP group: 141 months, TAP group: 147 months; p = 0.191). During the follow-up periods, there were 12 reoperations for the relief of right ventricular outflow tract obstruction (RVOTO), eight PVIs, and three late deaths. While freedom from reoperation for RVOTO was comparable between the two groups (p = 0.182), freedom from PVI at postoperative 15 years was significantly lower in the TAP group than in the AP group (74 and 100 %, p = 0.015). In repairing ToF with marginally small pulmonary valve annulus, AP is associated with a lower risk of late postoperative PVI.

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Abbreviations

AP:

(Pulmonary) Annulus preservation

CPB:

Cardiopulmonary bypass

IP:

Infundibular patch

PA:

Pulmonary artery

PVA-Z:

Z-score of the pulmonary valve annulus diameter

PVI:

Pulmonary valve implantation

RVOTO:

Right ventricular outflow tract obstruction

TAP:

Tansannular patch

ToF:

Tetralogy of Fallot

VSD:

Ventricular septal defect

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None of the authors have a financial relationship with a commercial entity that has an interest in the subject of the presented manuscript or other conflicts of interest to disclose.

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Authors and Affiliations

  1. Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea

    Gwan Sic Kim

  2. Division of Pediatric Cardiac Surgery, Asan Medical Center, University of Ulsan College of Medicine, 88, Olympic-ro 43-gil, Songpa-gu, Seoul, Republic of Korea

    Tae-Jin Yun

  3. Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, Seoul, Republic of Korea

    Seungbong Han

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  1. Gwan Sic Kim
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  2. Seungbong Han
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Correspondence to Tae-Jin Yun.

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Kim, G.S., Han, S. & Yun, TJ. Pulmonary Annulus Preservation Lowers the Risk of Late Postoperative Pulmonary Valve Implantation After the Repair of Tetralogy of Fallot. Pediatr Cardiol 36, 402–408 (2015). https://doi.org/10.1007/s00246-014-1021-4

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  • DOI: https://doi.org/10.1007/s00246-014-1021-4

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