Dedicated transpulmonic approach for the repair of Fallot's tetralogy (original) (raw)
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Long-term outcomes of transatrial-transpulmonary repair of tetralogy of Fallot
European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, 2015
The surgical approach to repair of tetralogy of Fallot (ToF) has shifted over the years. We aimed to report the long-term follow-up after ToF repair with the transatrial-transpulmonary approach and to determine predictors of long-term outcomes. Retrospective analysis of patients operated on in two tertiary referral centres. Primary outcome measures were: death, pulmonary valve replacement (PVR), reintervention for other reasons, internal cardiodefibrillator and/or pacemaker placement. Kaplan-Meier assessment of overall and event-free survival as well as uni- and multivariate analyses of risk factors for outcomes were performed. Four hundred and fifty-three patients were included. Median age at operation was: 0.6 years (range 0-19.6) and median age at the last follow-up was 14.3 years (range 0.1-42.1). Median age at repair decreased from 1.2 years (range 0.6-5.8) (1970-80) to 0.3 years (range 0-4.7) (2000-12). A transannular patch (TP) was used in 65% of all patients. The use of a TP...
Cardiology Research and Cardiovascular Medicine, 2017
Background: Tetralogy of Fallot (TOF) is one of the common cyanotic heart diseases. Now total repair is spreading to save children at younger age and lower body weight. The aim of this study was to evaluate the results of the two different surgical techniques used for total repair of tetralogy of Fallot: transatrial-transpulmonary approach and transventricular approach with special emphasis on preoperative and intraoperative risk factors that affecting the prognosis of patients, and with analysis of postoperative short-term results. Patients and Methods: Between January 2014 and December 2016, sixty patients with TOF were randomly collected in a prospective study. Children divided into two groups, Group A included 30 patients repaired through transatrial-transpulmonary approach. Group B included 30 patients repaired through transventricular approach. Results: Preoperative characteristics and variables of patients were similar. As regard to cardiopulmonary bypass time, crossclamp time there were no significant differences(p>0.05). There were significant differences in ventilation time (p 0.023), inotropic support (p 0.001) and duration of stay in the ICU (p0.001). The incidence of arrhythmia 2 patients (6.7%) vs.5 patients (16.7%)] with non-significant difference. There is significant difference in right/left ventricular pressure ratio (p<0.05). At follow up, Comparisons between both groups showed no significant differences as regard to RV pressure and PG across the RVOT (P>0.05). None of our children needed reintervention for residual VSD or significant RVOTO. There were three mortalities (5%), one in group A due to RV dysfunction and two in group B due to ventricular arrhythmia and RV dysfunction. Conclusion: Total repair is the primary choice for management of FallotTetralogy.We encourage transatrial-transpulmonary repair to avoid ventricular incisions, otherwise a limited ventriculotomy is sufficient rather than extended ventriculotomy with transannular repair.
Journal of Cardiothoracic and Vascular Anesthesia, 1999
T etralogy of Fallot was among the first congenital cardiac abnormalities to be repaired. 1 The surgical strategy has been dominated worldwide by the technique initially described, the trans-right ventricular approach. In 1963 an alternate strategy for repair, combining transatrial and transpulmonary approaches, was described by Hudspeth and colleagues. 2 This technique has since been favored by some centers. 3-7 The functional benefits include a lower incidence of arrhythmia and lower incidence and severity of early and late postoperative dysfunction of the right ventricle (RV). 8-12 Objectives: The study's object was to analyze the outcomes of transatrialtranspulmonary repair in children with tetralogy of Fallot and anomalous coronary artery crossing the right ventricular outflow tract. Methods: The transatrial-transpulmonary approach was used in 611 consecutive repairs, 36 (5.9%) of which were associated with a surgically relevant coronary artery anomaly. The median age and weight of the patients at repair were 23 months (2.8-170 months) and 9.9 kg (5.2-41 kg), respectively. Anomalies included left anterior descending coronary artery from right coronary artery or single right coronary artery (n = 22), right coronary artery from left coronary artery or left anterior descending coronary artery (n = 8), and large right coronary artery conal branch (n = 6). Diagnosis was established before the operation in 25 of 36 cases by angiography (n = 24) or echocardiography (n = 1). The approach was successful in 34 cases, in 25 of which placement of a limited transannular patch was necessary. Two patients had a right ventricle-pulmonary artery conduit as a result of proximity of the coronary branch to the pulmonary arterial anulus and inability to adequately relieve the right ventricular outflow tract obstruction. Results: There have been no early or late deaths. Mean right ventricle-pulmonary artery gradient at last follow-up was 19 mm Hg (95% confidence interval 14.5-24 mm Hg), compared with 15 mm Hg (95% confidence interval 12.5-17.5 mm Hg) for patients with normal coronary arteries (P = .3). Actuarial freedom from reoperation at 120 months was 96.5% (95% confidence interval 79.8%-99.5%) and was also similar between patients with and without coronary artery abnormalities (P = .92). Conclusions: Surgically important coronary anomalies in tetralogy of Fallot can be dealt with through the transatrial-transpulmonary approach in most cases without major alterations in technique. Outcomes are similar to those of other patients with tetralogy of Fallot. The presence of anomalous coronary arteries does not impart incremental risk after this surgical strategy.
International Surgery Journal, 2020
Background: The objective of this study was to evaluate the early and mid-term outcome of total correction of tetralogy of Fallot (TOF) done through transatrial approach avoiding ventriculotomy with or without transannular patching. Methods: Of 210 patients undergoing total correction for TOF between January 2016 and January 2019, 180 patients were operated via transatrial approach. The ventricular septal defect closure, infundibular resection and pulmonary valvotomy were performed through the right atrium. Age ranged from 12 months to 44 years (mean, 2.6 years), 104 patients were male and 76 patients were females. Results: Three patients (1.67%) died in early post-operative period. Pulmonary complications were seen in 8 (4.44%), septicemia in 1 (0.55%), low output syndrome in 2 (1.10%) and temporary arrhythmias in 6 (3.33%) patients. Reintubation was needed in 3 (1.67%) patients. Early reoperation was needed in 3 (1.67%) patients in view of post-operative bleeding. There were no mediastinal or deep sternal wound infections. None of our patient had complete heart block. There were no late deaths or late reoperations. Echocardiography before discharge did not reveal significant residual VSD in any patient. The mean right ventricular outflow tract pressure gradient was 28 mmHg (range of 20 to 44 mmHg) which decreased on follow-up echocardiography to 16 mmHg (range of 14 to 24 mmHg) at mean follow up of 23 months. None of our patient had severe pulmonary or tricuspid regurgitation or severe right ventricular dysfunction on follow up. Conclusions: Transatrial repair of TOF is associated with remarkably low morbidity and mortality in our early experience.
2021
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 categ...
Hemodynamic evaluation of 221 patients after intracardiac repair of tetralogy of Fallot
The American Journal of Cardiology, 1974
Cardiac catheterization and angiocardiographic studies were performed in 221 patients an average of 2 years (range 2 weeks to 10 years) after intracardiac repair of tetralogy of Fallot. The group represented 32.5 percent of the postoperative survivors. The postoperative result was classified as "excellent" (43 percent), "good" (35 percent), "satisfactory" (7 percent) or "unsatisfactory" (14 percent) on the basis of right ventricular peak systolic pressure, right ventricle to pulmonary artery peak systolic gradient and presence of a persistent large or small left to right shunt at the ventricular level. Unsatisfactory results were associated with obstructive pulmonary vascular disease (four patients), severe malformations with obstruction of the right ventricular outflow tract and/or a left to right shunt with a Qp:Qs ratio of greater than 1.51 or with currently uncorrectable obstructive anomalies of the right ventricular outflow tract or pulmonary arteries.