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Pediatric Cardiology

, Volume 37, Issue 5, pp 818–825 | Cite as

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

  • Danielle Gottlieb Sen
  • Marc Najjar
  • Betul Yimaz
  • Stéphanie M. Levasseur
  • Bindu Kalessan
  • Jan M. Quaegebeur
  • Emile A. BachaEmail author
Original Article

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

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

Notes

Compliance with Ethical Standards

Conflict of interest

The authors declare that they have no conflict of interest.

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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Danielle Gottlieb Sen
    • 1
    • 2
  • Marc Najjar
    • 1
  • Betul Yimaz
    • 3
    • 4
  • Stéphanie M. Levasseur
    • 1
  • Bindu Kalessan
    • 1
  • Jan M. Quaegebeur
    • 1
  • Emile A. Bacha
    • 1
    Email author
  1. 1.Pediatric Cardiac Surgery, Morgan Stanley Children’s Hospital of New York-PresbyterianColumbia UniversityNew YorkUSA
  2. 2.Pediatric Cardiac SurgeryNew Orleans Children’s HospitalNew OrleansUSA
  3. 3.Pediatric Cardiology, Morgan Stanley Children’s Hospital of New York-PresbyterianColumbia UniversityNew YorkUSA
  4. 4.Pediatric CardiologyTexas Children’s HospitalHoustonUSA

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