Clinical outcome of right ventricle outflow tract management for repair of Tetralogy of Fallot with three contemporary surgical strategies.

Tariq Waqar,M Zubair Ahmed Ansari,Kamran Khan

doi:10.12669/pjms.37.5.3961

Abstract

Objective:To compare the early operative outcome of TOF repair with three contemporary repair strategies of RVOTO repair i.e. TAP, Mono-cusp construction (MC) in TAP and pulmonary valve repair.Methods:Study is performed at Punjab Institute of Cardiology, Lahore from May 2016 to April 2020. Retrospective analysis of data was performed for patient who underwent TOF repair by three different strategies of RVOT repairs during TOF surgery based on z scoring for pulmonary valve annulus. Group-I underwent trans-annular patch repair, while Group-II and III underwent Mono-cusp repair with autologous pericardium and pulmonary valve repair respectively. Analysis of Variance (ANOVA) and Pearson Chi-Square (PCS) statistics were used to compare the three groups for numeric and categorical variables respectively. Post-hoc t-test and Bonferroni correction were performed for numeric data to compare two groups with each other. Chi-square test was used to perform comparison between groups for categorial variables.Results:ANOVA for aortic cross clamp time, total CPB time, Post-operative mechanical ventilation time, ICU stay and hospital stay showed statistical difference among all three group with p-value less than 0.05 however post hoc T-test showed this variation is limited to post-operative mechanical ventilation only when groups compared with each other. PCS showed there was difference for incidence of difficult weaning from CPB when all three groups compared while there was no difference in operative mortality with p-value of 0.15. However, Group-II comparison with Group-I showed that weaning from CPB was superior in-Group-II with p-value of 0.016. Group-III showed the best statistics for all operative outcome variables among all three groups. Comparison of incidence of post-operative moderate pulmonary regurgitation before discharge between Group-II and Group-III showed significant difference with p-value of 0.0052.Conclusion:PV repair strategy should be employed for RVOT repair of TOF whenever feasible. MC repair showed fewer hours of postoperative mechanical ventilation and higher incidence of easy weaning from CPB when compared to TAP, however its impacts over ICU stay, Hospital stay and operative mortality is not profound in our TOF repair population.

Highlights

Tetralogy of Fallot (TOF) is characterized by ventricular septal defect (VSD), right ventricular outflow tract (RVOT) obstruction, Right ventricle (RV) have diversities hypertrophy and overriding of aorta.[1]
Cases were segregated into three groups on the basis of repair strategy for RVOTO i.e. Trans-annular patch repair (Group-I), Mono-cusp repair (Group-II), and pulmonary valve repair (Group-III)
Table-I summarized the baseline characters of patient population, operative information and early operative outcome that underwent surgical repair of TOF with Transa-annular Patch repair (TAP) (Group-I) or Mono-cusp construction (MC) repair (GroupII) or PV repair (Group-III)

Summary

Introduction

Tetralogy of Fallot (TOF) is characterized by ventricular septal defect (VSD), right ventricular outflow tract (RVOT) obstruction, Right ventricle (RV) have diversities hypertrophy and overriding of aorta.[1]. Many other associated congenital malformations can be coexisting like patent ductus arteriosus (PDA), major aorto-pulmonary collaterals (MAPCAs), absent pulmonary valve small pulmonary artery and it branches etc.[2] every TOF presents somewhat differently during surgical handling and manipulation. Surgical repair of TOF is mainly based on closure of VSD and relieving of RVOT obstruction with ultimate improvement in all four components of congenital anomaly. RVOTO of TOF is caused at different levels i.e. 10% have PV stenosis, 50% have infundibular stenosis, 30% have mixture of above two while remaining have other more complex presentation like atresia of PV or pulmonary artery stenosis etc.[3]

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