RF64 PULMONARY VALVE SPARING STRATEGIES IN TETRALOGY OF FALLOT REPAIR: A SINGLE CENTER EXPERIENCE

Abstract

Background-Aim: Transannular patch (TAP) repair of tetralogy of Fallot (TOF) leads to chronic volume overload and significant late morbidity mortality. The pulmonary valve (PV) sparing strategy reduces pulmonary regurgitation with better long-term prognosis. The aim of this study is to examine the determinants for a successful PV-sparing strategy, by exploring PV morphology, annulus diameter, Z-scores and right/left ventricle pressures (Prv/Plv) ratio. Methods: From January 2005 to May 2017, 79 patients underwent TOF repair. 55.7% were males and 44.3% females. Depending on PV Z-scores, annulus size and morphology of PV, 21(26.6%) patients, Group A, underwent valve-sparing TOF repair and 58(73.4%), Group B, TAP approach. Data were retrospectively examined. Results: The median age was 33.7months in Group A and 21.7months in Group B. Mean PV annulus and PV Z-score were respectively 10.2 ± 2.9 mm and -1.6 ± 1.6, in Group A, and 7.5 ± 3.3 mm and -3.4 ± 2.0, in Group B. Mean Prv/Plv ratio was 0.6 ± 0.1 in Group A and 0.5 ± 0.2 in Group B. Z-scores were significantly higher (p = 0.0001) in Group A, while incidence of post-operative complications and reoperations were higher in Group B (p = 0.006 and p = 0.001, respectively). In hospital and ICU length of stay were significantly shorter (p = 0.03; p = 0.01) in Group A. Median follow-up was 27.6months in Group A and 64.8months in B. Conclusions: PV-sparing approach, whenever feasible, preserves RV function, reduces post-operative complications, leading to better long-term prognosis. 4 feasibility indicators must be taken into account: pre-operative PV Z-score higher than -3, adequate PV morphology and annulus according to age and BSA and intra-operative Prv/Plv ratio <0.75.