Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot

Massimo A. Padalino, Giacomo Cavalli, Sonia B. Albanese, Carlo Pace Napoleone, Alvise Guariento, Maria Teresa Cascarano, Martina Perazzolo Marra, Vladimiro Vida, Giovanna Boccuzzo, Giovanni Stellin

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Abstract

Background and Aim of the Study: Outcomes after repair of tetralogy of Fallot (TOF) are good with either a transventricular (TV) or transatrial (TA) approach. We sought to determine if there is a relationship between the TV or TA approach and right ventricular (RV) function, and the role of residual pulmonary regurgitation (PR) on the long-term outcomes. Methods: This was a retrospective cohort multicentric study on survivors after surgical repair of TOF (TA versus TV approach, ±transannular patch) between 1990 and 2004. All patients underwent magnetic resonance imaging to assess RV volume, function, and PR. Patients were matched for length of follow-up and age. Clinical adverse events were retrieved from institutional databases. Results: Seventy-nine patients (TA/TV = 37/42, median age 0.3 and 1.0 yrs, respectively) were included. At a median follow-up of 16.6 years (12.5-20.3), there were no differences in freedom from reintervention (either catheter or surgical), RV volumes, function, and PR between the TA and TV groups. Pulmonary valve (PV) replacement was significantly less frequent in the TA subgroup (P = 0.033) and patients with a preserved PV showed significantly lower RV volumes and less adverse events at follow-up. Conclusions: There is no significant difference in RV volumes and function between the TA and TV. However, the TA approach seems to be protective against PV replacement in the long-term. When PV is not preserved at repair, residual pulmonary regurgitation is a significant cause of late RV dysfunction and dilation, and is associated with a higher rate of late adverse events.

Original languageEnglish
Pages (from-to)712-720
Number of pages9
JournalJournal of Cardiac Surgery
Volume32
Issue number11
DOIs
Publication statusPublished - Nov 1 2017
Externally publishedYes

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Pulmonary Valve Insufficiency
Pulmonary Valve
Right Ventricular Function
Tetralogy of Fallot
Right Ventricular Dysfunction
Survivors
Dilatation
Cohort Studies
Catheters
Magnetic Resonance Imaging
Outcome Assessment (Health Care)
Databases

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

Cite this

Padalino, M. A., Cavalli, G., Albanese, S. B., Pace Napoleone, C., Guariento, A., Cascarano, M. T., ... Stellin, G. (2017). Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot. Journal of Cardiac Surgery, 32(11), 712-720. https://doi.org/10.1111/jocs.13236

Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot. / Padalino, Massimo A.; Cavalli, Giacomo; Albanese, Sonia B.; Pace Napoleone, Carlo; Guariento, Alvise; Cascarano, Maria Teresa; Perazzolo Marra, Martina; Vida, Vladimiro; Boccuzzo, Giovanna; Stellin, Giovanni.

In: Journal of Cardiac Surgery, Vol. 32, No. 11, 01.11.2017, p. 712-720.

Research output: Contribution to journalArticle

Padalino, MA, Cavalli, G, Albanese, SB, Pace Napoleone, C, Guariento, A, Cascarano, MT, Perazzolo Marra, M, Vida, V, Boccuzzo, G & Stellin, G 2017, 'Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot', Journal of Cardiac Surgery, vol. 32, no. 11, pp. 712-720. https://doi.org/10.1111/jocs.13236
Padalino, Massimo A. ; Cavalli, Giacomo ; Albanese, Sonia B. ; Pace Napoleone, Carlo ; Guariento, Alvise ; Cascarano, Maria Teresa ; Perazzolo Marra, Martina ; Vida, Vladimiro ; Boccuzzo, Giovanna ; Stellin, Giovanni. / Long-term outcomes following transatrial versus transventricular repair on right ventricular function in tetralogy of Fallot. In: Journal of Cardiac Surgery. 2017 ; Vol. 32, No. 11. pp. 712-720.
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AU - Padalino, Massimo A.

AU - Cavalli, Giacomo

AU - Albanese, Sonia B.

AU - Pace Napoleone, Carlo

AU - Guariento, Alvise

AU - Cascarano, Maria Teresa

AU - Perazzolo Marra, Martina

AU - Vida, Vladimiro

AU - Boccuzzo, Giovanna

AU - Stellin, Giovanni

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N2 - Background and Aim of the Study: Outcomes after repair of tetralogy of Fallot (TOF) are good with either a transventricular (TV) or transatrial (TA) approach. We sought to determine if there is a relationship between the TV or TA approach and right ventricular (RV) function, and the role of residual pulmonary regurgitation (PR) on the long-term outcomes. Methods: This was a retrospective cohort multicentric study on survivors after surgical repair of TOF (TA versus TV approach, ±transannular patch) between 1990 and 2004. All patients underwent magnetic resonance imaging to assess RV volume, function, and PR. Patients were matched for length of follow-up and age. Clinical adverse events were retrieved from institutional databases. Results: Seventy-nine patients (TA/TV = 37/42, median age 0.3 and 1.0 yrs, respectively) were included. At a median follow-up of 16.6 years (12.5-20.3), there were no differences in freedom from reintervention (either catheter or surgical), RV volumes, function, and PR between the TA and TV groups. Pulmonary valve (PV) replacement was significantly less frequent in the TA subgroup (P = 0.033) and patients with a preserved PV showed significantly lower RV volumes and less adverse events at follow-up. Conclusions: There is no significant difference in RV volumes and function between the TA and TV. However, the TA approach seems to be protective against PV replacement in the long-term. When PV is not preserved at repair, residual pulmonary regurgitation is a significant cause of late RV dysfunction and dilation, and is associated with a higher rate of late adverse events.

AB - Background and Aim of the Study: Outcomes after repair of tetralogy of Fallot (TOF) are good with either a transventricular (TV) or transatrial (TA) approach. We sought to determine if there is a relationship between the TV or TA approach and right ventricular (RV) function, and the role of residual pulmonary regurgitation (PR) on the long-term outcomes. Methods: This was a retrospective cohort multicentric study on survivors after surgical repair of TOF (TA versus TV approach, ±transannular patch) between 1990 and 2004. All patients underwent magnetic resonance imaging to assess RV volume, function, and PR. Patients were matched for length of follow-up and age. Clinical adverse events were retrieved from institutional databases. Results: Seventy-nine patients (TA/TV = 37/42, median age 0.3 and 1.0 yrs, respectively) were included. At a median follow-up of 16.6 years (12.5-20.3), there were no differences in freedom from reintervention (either catheter or surgical), RV volumes, function, and PR between the TA and TV groups. Pulmonary valve (PV) replacement was significantly less frequent in the TA subgroup (P = 0.033) and patients with a preserved PV showed significantly lower RV volumes and less adverse events at follow-up. Conclusions: There is no significant difference in RV volumes and function between the TA and TV. However, the TA approach seems to be protective against PV replacement in the long-term. When PV is not preserved at repair, residual pulmonary regurgitation is a significant cause of late RV dysfunction and dilation, and is associated with a higher rate of late adverse events.

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