Neonatal or infantile palliation for Tetralogy of Fallot with or without pulmonary atresia: Modified Blalock–Taussig shunt versus restrictive right ventricle to pulmonary artery connection. A 20-year experience

Abstract

To compare mortality, morbidity and efficiency of modified Blalock–Taussig shunt (mBTS) versus restrictive right ventricle to pulmonary artery connection (RVPAc) in patients with Tetralogy of Fallot (TOF) and TOF with pulmonary atresia (TOF-PA). We performed a monocentric retrospective review of 198 patients (93 TOF and 105 TOF-PA) who had palliation between 1996 to 2016 in their first year of life. Patients with Major aorto-pulmonary collaterals were excluded. Median follow-up was 11.0 [95% CI: 5.8–16.2] years after palliation. Five patients were lost at the follow-up. Ninety-five patients underwent mBTS, and 103 had an RVPAc. Nakata index before palliation was 129 (80–170) mm 2 /m 2 in mBTS group and 100 (71–146) mm 2 /m 2 in RVPAc group ( P = 0.001). Weight at palliation was similar between mBTS and RVPAc patients ( P = 0.1). Age at the palliation was 12 days (7–24.7) in RVPAc group and 21 days (8–87.5) in mBTS group ( P = 0.0002). One hundred and seventy-five patients underwent repair and 5 are waiting for it. Among them 39 necessitated a repair with a pulmonary valve conduit (23 mBTS and 16 RVPAc P = 0.004). Two patients were unsuitable for repair. Eleven patients died before repair (5.7%). There was no difference in mortality rate regarding the type of palliation ( P = 0.92) or the anatomical group ( P = 0.76). Interstage reintervention before repair was n = 37 (20%). Thirty-three were surgical and four were percutaneous. No difference in reintervention rate between RVPAc or mBTS regarding the age, the weight at palliation or the anatomical group ( P = 0.56). The delay between the palliation and the complete repair was shorter in RVPAc [12.3 (6.3–37.9) months versus 6.5 (4.9–10.3) months for mBTS ( P < 0.01)]. RVPAc provide a better and a faster pulmonary artery growth in our population. It led us to limit the use of RVPAc conduit at the repair. We found no significant difference between mBTS and RVPAc for mortality and interstage reintervention.