VALVE-SPARING TETRALOGY OF FALLOT REPAIR PROVIDES BENEFITS FOR RV GEOMETRY AND CAN BE ACHIEVED IN ∼65% WITH LITTLE COST

Abstract

BACKGROUND: In tetralogy of Fallot (TOF), the risk of cyanotic spells can lead to emergency surgery like palliative systemicpulmonary shunt before the ideal time to do complete repair. During corrective surgery in case of insufficient development of the pulmonary valve, the use of a trans-annular patch is required which, in the long-term, causes excessive dilatation of the right ventricle, arrhythmia and sudden death. The development of the pulmonary branch and the onset of cyanotic spells are conditioned by the volume of the trans-valvular flow. METHODS: We conducted a retrospective study to determine whether elective primary pulmonary valvuloplasty (EPPV) in the neonatal period 1) allows a better development of the pulmonary valve and artery; 2) reduces the risk of cyanotic spells and the use of emergency surgery; 3) increase the possibilities of conservative surgery of the pulmonary valve. Patients with simple TOF who received an EPPV within the first month of live between 2000 and 2010were compared to an observational group (OBS).Main parameters included progress of O2-saturation, pulmonary valve and artery growth, need for urgent aorto-pulmonary shunt, need for trans-annular patch reconstruction. RESULTS: Of a total of 203 patients identified, 42 were analyzed (23 EPPV and 19 OBS). At birth O2-saturation was 91.52 7.12 respectively vs 94.16% 3.5%; p1⁄4 0.043; The Z score of the pulmonary valve was -3.01 2.12 vs 0.508 1.71 (p1⁄40.66) and Nakata index 115.12 39.67 vs 156.3 43.06 mm2/m2 (p1⁄40.001). At the time surgery the growth of pulmonary annulus was z-score: -3.47 2.09 (p1⁄40.73) vs -3.11 2.43 (p1⁄40.214). Nakata index increased to 174.51 93.74 (p1⁄4 0.57) in EPPV and to 151.19 74.14 (p1⁄40.14) in OBS, this increase was not significant between the 2 groups however (39.59 91.39 vs 4.85 78.34, p1⁄40.214). The need for pulmonary re-intervention after corrective surgery was lower in EPPV 4/22(18%) vs. OBS 6/20(30 %); p1⁄40.04. CONCLUSION: Neonatal EPPV in simple TOF allows appropriate growth of the pulmonary arteries and reduces the rate of re-intervention on the pulmonary arteries after corrective surgery. In this small series, there was no significant difference in the use of a transannular patch or on cyanotic spells.