Tetralogy of Fallot with an abnormal coronary artery: surgical options and prognostic factors.

نویسندگان

  • David M Kalfa
  • Alain E Serraf
  • Mohamedou Ly
  • Emmanuel Le Bret
  • Régine Roussin
  • Emre Belli
چکیده

OBJECTIVES The objectives were to determine in patients with Tetralogy of Fallot (ToF) and abnormal coronary artery (ACA): the long-term outcomes of different surgical strategies; the risk factors for right ventricular outflow tract (RVOT) obstruction, reoperation, heart failure and mortality. To date, the surgical strategies and prognostic factors for repair of ToF with an ACA, crossing the RVOT and avoiding a classic repair, have not been evaluated in a large series using a multivariate analysis. METHODS A retrospective study (1986-2011) included 72 patients. The mean follow-up was 9.6 ± 6.8 years. Median age at surgery was 1.5 years (0.2-11.3). The main surgical techniques were 'tailored' right ventriculotomy and patch of the RVOT (63%; n = 45), implantation of a conduit between the right ventricle (RV) and the pulmonary artery (PA; 25%; n = 18) and a transatrial ± transpulmonary approach (11%; n = 8). Univariate and multivariate logistic regression analyses were performed. RESULTS Intrahospital mortality was 2.7%. Actuarial freedom from reoperation and actuarial survival at 15 years were 77% (confidence interval [CI]: 70-83%) and 94% (CI: 90-97%), respectively. Reoperations occurred more frequently after conduit implantation (50%) than after patch reconstruction (17%) or transatrial ± transpulmonary approach (0%; P = 0.002). The transatrial ± transpulmonary approach was significantly less complicated, with a long-term RVOT obstruction of 0% compared with the other surgical techniques (45.4%; P = 0.03). Implantation of a RV-PA conduit was an independent risk factor for RVOT obstruction (odds ratio [OR]: 31; P < 0.001) and reoperation (OR: 20; P = 0.02). An immediate postoperative right ventricle/left ventricle (RV/LV) pressure ratio >0.5 was independently associated with a long-term RV/LV pressure ratio >0.5 (OR: 14; P = 0.001), but was not a risk factor for reoperation (P = 0.8). Postoperative electric ischaemic signs independently increased the risk of long-term heart failure (OR: 22; P = 0.04). CONCLUSIONS The transatrial ± transpulmonary approach displays the best long-term outcomes, by reducing the risks for RVOT obstruction and reoperation, but does not improve the patient survival. A RV-PA conduit was an independent risk factor for RVOT obstruction and reoperation. An immediate postoperative RV/LV pressure ratio >0.5 was not a risk factor for reoperation. The transatrial ± transpulmonary approach should be preferred to the implantation of a conduit or a tailored right ventriculotomy whenever possible.

برای دانلود رایگان متن کامل این مقاله و بیش از 32 میلیون مقاله دیگر ابتدا ثبت نام کنید

ثبت نام

اگر عضو سایت هستید لطفا وارد حساب کاربری خود شوید

منابع مشابه

Congenital Aortocaval Fistula from Right Subclavian Artery to Superior Vena Cava in an Adult with Tetralogy of Fallot

Congenital   aortocaval   fistula in association with complex congenital heart disease has never been described before. We represent an adult with tetralogy of fallot and an undiagnosed subclavian artery to superior vena cava fistula in previous catheterisms. He underwent surgical correction, successfully. After 8 months post operation he was doing well with improved functional capacity and no ...

متن کامل

Main indications and long-term outcomes of reoperation after initial repair of tetralogy of Fallot

Background and Objective: The aim of this study was to analyze our indications, surgical procedures, and clinical outcomes of patients undergoing reoperation after surgical correction of tetralogy of Fallot (TOF). Methods: Thirty seven consecutive patients who underwent reoperation late after intra-cardiac repair of TOF within a period of 10 years were assessed. Results: The most co...

متن کامل

Technical option on tetralogy of Fallot with abnormal coronary artery: cases report.

Report on two children, one 11 year-male and another one year-six-month-female with tetralogy of Fallot associated with anomalous origin of coronary artery crossing the right ventricle outlet tract. Diagnosis was done by echocardiography and cardiac catheterization. On surgical correction we used an external composite tubular pericardium bovine graft and posterior wall of the pulmonary artery b...

متن کامل

RADIOLOGY Results of Routine Preoperative Coronary Angiography in Tetralogy of Fallot

In the surgical repair of tetralogy of Fallot, morbidity and mortality are increased by certain coronary anomalies, in particular, an anterior descending branch originating from the right coronary artery or a single coronary artery in which a large coronary branch runs across the pulmonary outflow tract. In a series of 94 patients with tetralogy of Fallot who underwent cardiac catheterization, ...

متن کامل

Tetralogy of Fallot

In the surgical repair of tetralogy of Fallot, morbidity and mortality are increased by certain coronary anomalies, in particular, an anterior descending branch originating from the right coronary artery or a single coronary artery in which a large coronary branch runs across the pulmonary outflow tract. In a series of 94 patients with tetralogy of Fallot who underwent cardiac catheterization, ...

متن کامل

ذخیره در منابع من


  با ذخیره ی این منبع در منابع من، دسترسی به آن را برای استفاده های بعدی آسان تر کنید

عنوان ژورنال:
  • European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery

دوره 42 3  شماره 

صفحات  -

تاریخ انتشار 2012