Kobayashi, Yasuyuki Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science ORCID Kaken ID
Kotani, Yasuhiro Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science
Kuroko, Yosuke Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science,
Kawabata, Takuya Department of Cardiovascular Surgery, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Science
Sano, Shunji Division of Pediatric Cardiothoracic Surgery, University of California San Francisco Kaken ID publons researchmap
This study evaluated the impact of a staged surgical strategy incorporating a modified Blalock-Taussig shunt (BTS) for tetralogy of Fallot (TOF) on pulmonary valve annulus (PVA) growth, the rate of valve-sparing repair (VSR) at the time of intracardiac repair (ICR), and long-term functional outcomes.
This retrospective study included 330 patients with TOF who underwent ICR between 1991 and 2019, including 57 patients (17%) who underwent BTS. The mean follow-up period was 15.0±7.3 years. We compared the data of patients who underwent BTS and those who did not undergo BTS before ICR.
The median age and body weight before BTS were 71 (28–199) days and 4.3 (3.3–6.8) kg respectively. There were no in-hospital or interstage deaths after BTS. The PVA Z-scores of patients with BTS revealed significant growth after BTS (from -4.2±1.8 to -3.0±1.7, P<0.001). VSR was eventually performed in 207 (63%) patients, including 26 (46%) patients who underwent staged repair. The overall freedom from pulmonary regurgitation-related reintervention were 99.7%, 99.1%, and 95.8% at 1, 5, and 20 years, respectively.
A staged surgical strategy incorporating BTS as the first palliation for symptomatic patients resulted in no mortality. BTS may have contributed to the avoidance of primary transannular patch repair (TAP) and facilitated PVA growth; therefore, approximately half of the symptomatic neonates and infants were recruited for VSR. Staged repair may have led to functionally-reliable delayed TAP repair, thereby resulting in less surgical reinterventions.
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© 2021 by The Society of Thoracic Surgeons. This manuscript version is made available under the CC-BY-NC-ND 4.0 License.http://creativecommons.org/licenses/by-nc-nd/4.0/.This is the accepted manuscript version. The formal published version is available at [https://doi.org/10.1016/j.athoracsur.2021.01.087] .
This fulltext is available in Mar. 2022.
The Annals of Thoracic Surgery
The Society of Thoracic Surgeons
© 2021 by The Society of Thoracic Surgeons
Kobayashi Y, Kotani Y, Kuroko Y, Kawabata T, Sano S, Kasahara S. Staged Repair of Tetralogy of Fallot: A Strategy for Optimizing Clinical and Functional Outcomes. Ann Thorac Surg. 2021 Mar 23:S0003-4975(21)00551-8. doi: 10.1016/j.athoracsur.2021.01.087.
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