Right ventricular outflow tract stenting is a feasible and effective palliation for critical tetralogy of Fallot, with early mortality of less than 2% in published series.
Does right ventricular outflow tract (RVOT) stenting provide effective palliation compared to surgical palliation in patients with critical tetralogy of Fallot?
RVOT stenting is a feasible and effective alternative to surgical palliation in critical TOF, offering low early mortality and balanced pulmonary artery growth.
Background. Despite current trends toward early primary repair, the surgical systemic-to-pulmonary shunt is still considered the first-choice palliation in patients with critical tetralogy of Fallot (TOF) and duct-dependent pulmonary circulation unsuitable for primary repair. However, stenting of the right ventricular outflow tract (RVOT) is nowadays emerging as an effective alternative to surgical palliation in selected patients. Methods and results. RVOT stenting is usually performed from a venous route, either femoral or, in selected cases, the right internal jugular vein. Less frequently, mostly in pulmonary infundibular/valvar atresia, this procedure can be performed using a hybrid surgical/interventional approach by surgical exposure of the RVOT, puncture of the atretic valve, and stent deployment under direct vision. The size and type of the most appropriate stent may be chosen, based on ultrasound measurements of the RVOT, to cover the right ventricular infundibulum completely and, at the same time, sparing the pulmonary valve, unless significant pulmonary valve annulus hypoplasia and/or supra-valvular stenosis is a significant component of the obstruction. In the large series so far published, early mortality of RVOT stenting is less than 2%, comparing favourably with either Blalock-Thomas-Taussig shunt or early primary repair. In addition, morbidity and clinical sequelae of this approach do not significantly differ from surgical palliation, even if RVOT stenting shows lesser durability and a higher rate of trans-catheter re-interventions over a mid-term follow-up. Finally, similar but more balanced pulmonary artery growth than surgical palliation following RVOT stenting is reported over a mid-term follow-up. Conclusions. RVOT stenting is a technically feasible, well-tolerated, and effective palliation in critical TOF. This approach is cost-effective with respect to surgical palliation either in high-risk neonates or whenever a short-term pulmonary blood flow source is anticipated due to the early surgical repair. It effectively increases pulmonary blood flow, improves arterial saturation, and promotes balanced pulmonary artery growth over a mid-term follow-up.
Pizzuto et al. (Thu,) conducted a review in Critical tetralogy of Fallot (TOF). Right ventricular outflow tract (RVOT) stenting vs. Surgical palliation (Blalock-Thomas-Taussig shunt) or early primary repair was evaluated on Early mortality. Right ventricular outflow tract stenting is a feasible and effective palliation for critical tetralogy of Fallot, with early mortality of less than 2% in published series.