title: Aiming to Preserve Pulmonary Valve Function in Tetralogy of Fallot Repair: Comparing a New Approach to Traditional Management.
abstract: Pulmonary valve (PV) incompetence following transannular patch (TAP) repair of tetralogy of Fallot (TOF) results in long-term morbidity and mortality. Valve-sparing repairs have recently gained recognition; however, they may be associated with residual pulmonary stenosis (PS) in patients with small PV z scores. We sought to determine whether a repair that increases the PV annulus and augments the valve leaflet with a biomaterial would result in annular growth and in longer duration of valve competence compared with TAP. Eighty patients (median age 136 days, range 4-350) who underwent surgical repair of TOF between 2010 and 2014 were included in the study. Patients were divided into three groups based on the PV intervention: balloon dilation/valvotomy (n = 29), valve-sparing transannular repair (VSTAR) (n = 19) and TAP (n = 32). Intraoperative, early postoperative and midterm follow-up echocardiographic data (median 19 months, range 1-59) were obtained. The primary outcomes were the presence and severity of pulmonary regurgitation and/or PS. Compared with TAP, VSTAR patients demonstrated significantly less severe PR with 100 % freedom of severe PR immediately post-op (vs. 0 % in TAP), 60 % at 6 months and 20 % at 20 months. There were no differences in PS between VSTAR and TAP at follow-up. A subgroup analysis of the VSTAR group was performed. PV z scores were calculated and fit to a random effects model. Patient data fit the model closely, predicting a reproducible increase in valve annulus size over time. With better short-term and comparable midterm results, VSTAR may be appropriate for TOF repair in patients with small PV that would conventionally require a TAP.
authors.affiliation: Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.|Pediatric Cardiac Surgery, New Orleans Children's Hospital, New Orleans, LA, USA.
authors.forename: Danielle Gottlieb
authors.initials: DG
authors.lastname: Sen
authors.affiliation: Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.
authors.forename: Marc
authors.initials: M
authors.lastname: Najjar
authors.affiliation: Pediatric Cardiology, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.|Pediatric Cardiology, Texas Children's Hospital, Houston, TX, USA.
authors.forename: Betul
authors.initials: B
authors.lastname: Yimaz
authors.affiliation: Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.
authors.forename: Stéphanie M
authors.initials: SM
authors.lastname: Levasseur
authors.affiliation: Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.
authors.forename: Bindu
authors.initials: B
authors.lastname: Kalessan
authors.affiliation: Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA.
authors.forename: Jan M
authors.initials: JM
authors.lastname: Quaegebeur
authors.affiliation: Pediatric Cardiac Surgery, Morgan Stanley Children's Hospital of New York-Presbyterian, Columbia University, New York, NY, USA. eb2709@cumc.columbia.edu.
authors.forename: Emile A
authors.initials: EA
authors.lastname: Bacha
mesh_terms: D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D011664:Pulmonary Valve; D011665:Pulmonary Valve Insufficiency; D012189:Retrospective Studies; D013771:Tetralogy of Fallot; D016896:Treatment Outcome
keywords: Pulmonary valve; Tetralogy of Fallot; Transannular patch repair; Valve-sparing repair