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An Evaluation of Predictive Factors for Pulmonary Valve Replacement after Total Correction in Children with tetralogy of Fallot

Document Type : original article

Authors

1 Pediatric Cardiology Department, Pediatric Health research Center, Tabriz University of Medical Sciences, Tabriz, Iran

2 Medicine Doctor, Pediatric Health research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

3 Pediatric cardiology Department, Pediatric Health research Center, Tabriz University of Medical Sciences, Tabriz, Iran

4 Pediatric Health research Center, Tabriz University of Medical Sciences, Tabriz, Iran.

5 Pediatric Health research Center, Tabriz University of Medical Sciences, Tabriz, Iran

Abstract

Background: Congenital heart defects, with a prevalence of 4-8 cases per 1000 births, are one of the most common congenital defects. Tetralogy of Fallot (ToF) is the most common congenital cyanotic disease. There are several techniques for correcting this anomaly and ToF total correction is a routine option. Approximately 40% of patients undergoing ToF, need Pulmonary Valve Replacement (PVR) in the years after primary surgery. In this study, we investigated the predictive factors of PVR in patients with ToF.
Method: The participants included 204 ToF patients who had undergone ToFTC surgery during 2004-2020. Many factors inducing age, sex, weight, pre-ToFTC echocardiographic findings, pre-ToFTC angiographic findings, pre-ToFTC palliative care, type of ToFTC surgery, and echocardiographic features of PVR were extracted and studied.
Results: The mean age at ToFTC was 27.8 months in the PVR group and 58.8 months in ToFTC + PVR group (P < 0.001). Among echocardiographic findings before ToFTC surgery, RV function (P = 0.003), RPA (P = 0.015) and MPA (P = 0.036) were significantly different between the two groups. Valvotomy + VSD Closure surgery were significantly more prevalent among ToFTC patients (P = 0.001); however, Transannular Patch and Monocusp Implantation were done at higher rates among PVR patients. More palliative care before surgery was reported among PVR patients (P = 0.001), but ASD repair was more prevalent in the other group (P < 0.001) which was probably due to two more prevalence of ASD among patients of ToFTC group.
Conclusion: Need for PVR surgery is affected by several factors, including demographic characteristics of patients and characteristics of surgical interventions, along with the anatomical and functional features of the heart.

Keywords

References
  1. Evans WN. “Tetralogy of Fallot” and Etienne-Louis Arthur Fallot. Pediatr Cardiol. 2008 May; 29(3):637–40.
  2. Ferencz C, Rubin JD, McCarter RJ, Brenner JI, Neill CA, Perry LW, Hepner SI, Downing JW. Congenital heart disease: prevalence at livebirth. The Baltimore-Washington Infant Study. Am J Epidemiol. 1985 Jan; 121(1):31–6.
  3. Olney RS, Ailes EC, Sontag MK. Detection of critical congenital heart defects: Review of contributions from prenatal and newborn screening. Semin Perinatol. 2015; 39(3):230–7.

4. Talner CN. Report of the New England Regional Infant Cardiac Program, by 

Donald C. Fyler, MD, Pediatrics, 1980; 65(suppl):375-461. Pediatrics. 1998 Jul; 102(1 Pt 2):258–9.

  1. Ferencz C. Epidemiology of congenital heart disease: the Baltimore-Washington Infant Study 1981-1989. Futura Publishing Company; 1993.
  2. Apitz C, Webb GD, Redington AN. Tetralogy of Fallot. Lancet (London, England). 2009 Oct; 374(9699):1462–71.
  3. Haas NA, Schirmer KR. Guidelines for the management of congenital heart diseases in childhood and adolescence. Cardiol Young. 2017; 27(S3):S1–105.
  4. Lillehei CW, Cohen M, Warden HE, Read RC, Aust JB, Dewall RA, Varco RL. Direct vision intracardiac surgical correction of the tetralogy of Fallot, pentalogy of Fallot, and pulmonary atresia defects; report of first ten cases. Ann Surg. 1955 Sep; 142(3):418–42.
  5. Lillehei CW, Varco RL, Cohen M, Warden HE, Gott VL, DeWall RA, Patton C, Mller JH. The first open heart corrections of tetralogy of Fallot. A 26-31 year follow-up of 106 patients. Ann Surg. 1986 Oct; 204(4):490–502.
  6. Hickey EJ, Veldtman G, Bradley TJ, Gengsakul A, Manlhiot C, Williams WG, Webb GD, McCrindle BW. Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J cardio-thoracic Surg off J Eur Assoc Cardio-thoracic Surg. 2009 Jan; 35(1):156–64; discussion 164.
  7. Kirklin JW, Blackstone EH, Pacifico AD, Kirklin JK, Bargeron LMJ. Risk factors for early and late failure after repair of tetralogy of Fallot, and their neutralization. Thorac Cardiovasc Surg. 1984 Aug; 32(4):208–14.
  8. Kim H, Sung SC, Kim S-H, Chang YH, Lee HD, Park JA, Lee YS. Early and late outcomes of total repair of tetralogy of Fallot: risk factors for late right ventricular dilatation. Interact Cardiovasc Thorac Surg. 2013 Dec; 17(6):956–62.
  9. Mouws EMJP, de Groot NMS, van de Woestijne PC, de Jong PL, Helbing WA, van Beynum IM, AdJJC Bogers. Tetralogy of Fallot in the Current Era. Semin Thorac Cardiovasc Surg [Internet]. 2019; 31(3):496–504. Available from: https://linkinghub.elsevier.com/retrieve/pii/S1043067918303149.
  10. Sfyridis PG, Kirvassilis G V, Papagiannis JK, Avramidis DP, Ieromonachos CG, Zavaropoulos PN, Sarris GE. Preservation of right ventricular structure and function following transatrial-transpulmonary repair of tetralogy of Fallot. Eur J cardio-thoracic Surg off J Eur Assoc Cardio-thoracic Surg. 2013 Feb; 43(2):336–42.
  11. Mercer-Rosa L, Yang W, Kutty S, Rychik J, Fogel M, Goldmuntz E. Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot: a comparative analysis of echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging. 2012 Sep; 5(5):637–43.
  12. Hoashi T, Kagisaki K, Meng Y, Sakaguchi H, Kurosaki K, Shiraishi I, Yagihara T, Ichikawa H. Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus. J Thorac Cardiovasc Surg. 2014 Sep; 148(3):802–9.
  13. Carvalho JS, Shinebourne EA, Busst C, Rigby ML, Redington AN. Exercise capacity after complete repair of tetralogy of Fallot: deleterious effects of residual pulmonary regurgitation. Br Heart J. 1992 Jun; 67(6):470–3.
  14. Gatzoulis MA, Till JA, Somerville J, Redington AN. Mechanoelectrical interaction in tetralogy of Fallot. QRS prolongation relates to right ventricular size and predicts malignant ventricular arrhythmias and sudden death. Circulation. 1995 Jul; 92(2):231–7.
  15. Khairy P, Landzberg MJ, Gatzoulis MA, Lucron H, Lambert J, Marçon F, Alexander ME, Walsh EP. Value of programmed ventricular stimulation after tetralogy of fallot repair: a multicenter study. Circulation. 2004 Apr; 109(16):1994–2000.
  16. Wolf md, landtman b, neill ca, taussig hb. Total correction of tetralogy of fallot. I. Follow-up study of 104 cases. Circulation. 1965 Mar; 31:385–93.
  17. Azar H, Hardesty RL, Pontius RG, Zuberbuhler JR, Bahnson HT. A review of total correction in 200 cases of tetralogy of Fallot. Arch Surg. 1969 Aug; 99(2):281–5.
  18. Kirklin JW, Wallace RB, McGoon DC, DuShane JW. Early and late results after intracardiac repair of Tetralogy of Fallot. 5-Year review of 337 patients. Ann Surg. 1965 Oct; 162(4):578–89.
  19. Ebert PA, Sabiston DCJ. Surgical management of the tetralogy of Fallot: influence of a previous systemic-pulmonary anastomosis on the results of open correction. Ann Surg. 1967 May; 165(5):806–13.
  20. Bristow Jd, Adrouny Za, Porter Ga, Menashe Vd, Star A, Griswold He. Hemodynamic studies after total correction of tetralogy of Fallot. Am J Cardiol. 1962 Jun; 9:924–32.
  21. Goldman BS, Mustard WT, Trusler GS. Total correction of tetralogy of Fallot. Review of ten years’ experience. Br Heart J. 1968 Jul; 30(4):563–8.
  22. Luijten LWG, van den Bosch E, Duppen N, Tanke R, Roos-Hesselink J, Nijveld A, Dijk Av, Bogers AdJJC, Domburg Rv, Helbing WA. Long-term outcomes of transatrial-transpulmonary repair of tetralogy of Fallot. Eur J cardio-thoracic Surg off J Eur Assoc Cardio-thoracic Surg. 2015 Mar; 47(3):527–34.
  23. Oosterhof T, van Straten A, Vliegen HW, Meijboom FJ, van Dijk APJ, Spijkerboer AM, Bouma BJ, Zwinderman AH, Hazekamp MG, Roos Ad, Mulder BJM. Preoperative thresholds for pulmonary valve replacement in patients with corrected tetralogy of Fallot using cardiovascular magnetic resonance. Circulation. 2007 Jul; 116(5):545–51.
  24. Bokma JP, Winter MM, Oosterhof T, Vliegen HW, van Dijk AP, Hazekamp MG, Koolbergen DR, Groenink M, Mulder BJ, Bouma BJ. Preoperative thresholds for mid-to-late haemodynamic and clinical outcomes after pulmonary valve replacement in tetralogy of Fallot. Eur Heart J. 2016 Mar; 37(10):829–35.
  25. Babu-Narayan S V, Diller G-P, Gheta RR, Bastin AJ, Karonis T, Li W, Li W, Pennell DJ, Uemura H, Sethia B, Gatzoulis MA, Shore DF. Clinical outcomes of surgical pulmonary valve replacement after repair of tetralogy of Fallot and potential prognostic value of preoperative cardiopulmonary exercise testing. Circulation. 2014 Jan; 129(1):18–27.
  26. O’Byrne ML, Glatz AC, Mercer-Rosa L, Gillespie MJ, Dori Y, Goldmuntz E, Kawut S, Rome JJ. Trends in Pulmonary Valve Replacement in Children and Adults with Tetralogy of Fallot. Am J Cardiol [Internet]. 2015 Jan; 115(1):118–24. Available from: https://linkinghub.elsevier.com/retrieve/pii/S0002914914019389
  27. van der Hulst AE, Hylkema MG, Vliegen HW, Delgado V, Hazekamp MG, Rijlaarsdam MEB, Holman ER, Blom NA, Roest AAW. Mild residual pulmonary stenosis in tetralogy of fallot reduces risk of pulmonary valve replacement. Ann Thorac Surg. 2012 Dec; 94(6):2077–82.
    1. Ylitalo P, Nieminen H, Pitkänen OM, Jokinen E, Sairanen H. Need of transannular patch in tetralogy of Fallot surgery carries a higher risk of reoperation but has no impact on late survival: results of Fallot repair in Finland. Eur J cardio-thoracic Surg off J Eur Assoc Cardio-thoracic Surg. 2015 Jul; 48(1):91–7.
    1. Mitropoulos FM, Kanakis MA, Ntellos C, Loukas C, Davlouros P, Kousi T, Chatzis AC. Pulmonary valve replacement in patients with corrected tetralogy of Fallot. J Cardiovasc Thorac Res [Internet]. 2017/05/04. 2017; 9(2):71–7. Available from: https:// pubmed. ncbi. nlm. nih. gov/28740625

     

International Journal of Pediatrics
Volume 11, Issue 7
July 2023
Pages 18055-18067
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