Right Ventricular Outflow Tract Reconstruction Using Transannular Patch with Pericardial Monocusp in Patients with Tetralogy of Fallot
Keywords:
Right ventricular outflow tract reconstruction, Tetralogy of Fallot, Transannular patch, MonocuspAbstract
Background: Tetralogy of Fallot is the most common cyanotic heart disease in Thailand. Many patients have stenosis involving the pulmonic valve (PV) annulus which requires complex surgical procedures to relieve the obstruction at this level, especially by using a transannular patch (TAP). We analyzed the early results of TAP with pericardial monocusp, and compared this with the results of non-TAP operations.
Methods: A retrospective medical record review was conducted which included 69 patients who underwent definitive cardiac repair between January 2009 to December 2018. The results of patients who underwent TAP with the pericardial monocusp technique were compared to those who underwent the non-TAP technique.
Results: There were 30 patients in the non-TAP group (mean age 92.6 months) and 39 patients in the TAP group (mean age 90.4 months). Most patients in both groups had favorable and comparable preoperative characteristics, except the mean PV annulus diameter in the TAP group was smaller than that in the non-TAP group (mean z-score in the TAP group, -2.2, in the Non-TAP group, 0.6, p-value < 0.001). Bypass times were longer in the TAP group (non-TAP group 107± 42 mins, TAP group 138 ± 37 mins, p-value 0.002). Cross-clamp times were longer as well (Non-TAP group 79 ± 27 mins, TAP group 102 ± 27 mins, p-value 0.001). In-hospital mortality rate was higher in the TAP group (Non-TAP group 7%, TAP group 23%). Overall survival was 88.4 % at 2 years (96.7% in non-TAP group, and 82.1% in TAP group). After exclusion of in-hospital deaths from both groups, freedom from at least moderate pulmonary stenosis or regurgitation at 2 years was 93.3 % in the non-TAP group, and 61.1 % in the TAP group, whereas freedom from re-intervention was excellent and comparable in both groups (Non-TAP group 100%, TAP group 96.4%).
Conclusion: TAP with monocusp technique can adequately relieve PV stenosis with good valvular function at least in the early period after surgery. Although the in-hospital mortality was higher with TAP, increasing experience should eventually reduce the mortality rate.
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