Key result
Post-surgical Tetralogy of Fallot repair is linked to significant aortic root dilatation vs healthy controls.
Why the study?
Despite early surgical repair of TOF, the aortic root often continues to dilate and elastic properties are deranged, potentially causing complications such as aortic regurgitation.
Do patients post-surgical repair of Tetralogy of Fallot have increased aortic root dilation and altered elastic properties compared to healthy controls?
Meta-Analysis (n=2,340)
Do patients post-surgical repair of Tetralogy of Fallot have increased aortic root dilation and altered elastic properties compared to healthy controls?
Effect estimate: SMD 2.547 (95% CI 1.536-3.559)
Patients with repaired Tetralogy of Fallot exhibit significant long-term aortic root dilation and impaired aortic elasticity compared to healthy controls, highlighting the need for ongoing surveillance.
Supports aortic surveillance after TOF repair; confirms dilation and stiffness in meta-analysis of case-control studies.
Introduction Aortic Root Dilatation (ARD) is a well-known long-term complication of Tetralogy of Fallot (TOF). Despite early repair allowing patients to lead healthy lives, the aortic root often continues to dilate, potentially leading to complications like aortic regurgitation. Elastic properties have also been found to be deranged in patients of TOF. This meta-analysis quantifies the degree of ARD and assesses aortic distensibility, stiffness, and strain in post-TOF repair patients. Purpose 1. To assess the degree of aortic root dilation in patients post-repair of Tetralogy of Fallot. 2. To assess and compare the distensibility, stiffness and strain of the aorta post-surgical correction of TOF against that of healthy controls. Methods A systematic review of literature was performed using the terms ‘aortic root dilation’, ‘aortic enlargement’, ‘sinus of valsalva dilation’, and ‘tetralogy of fallot’ on PubMed, Embase, SCOPUS, and Web of Science up to August 2024. Article screening and data extraction were carried out independently by two authors and discrepancies were resolved by a third author. We included case-control studies with postoperative TOF patients against healthy participants as controls. Only uncomplicated TOF cases, i.e., without atrial septal defects, shunt disorders, pulmonary atresia, etc. were included. Random effects meta-analysis was done using Stata after assessment of study heterogeneity. The Standardized Mean Difference (SMD) between patients and healthy controls was used as the measure of effect. Results We identified 14 studies with a total of 2340 participants (1540 patients and 800 controls). The aortic diameter was reported as absolute diameter or as Z-score and was found to be dilated in patients at various levels- aortic annulus (SMD: 1.179; 95% CI: -0.760-3.118); sinus of Valsalva (SMD: 2.547; 95% CI: 1.536-3.559); sino-tubular junction (SMD: 1.307; 95% CI: 0.370-2.244); ascending aorta (SMD: 2.383; 95% CI: 1.226-3.539); sinus of Valsalva Z-score (SMD: 1.724; 95% CI:1.476-1.972) and ascending aorta Z-score (SMD: 1.615; 95% CI: 1.487-1.744). Aortic distensibility and strain were decreased (SMD: -0.79; 95% CI: -1.20 to -0.38 and SMD: -0.70; 95% CI: -1.23 to -0.17 respectively), while aortic stiffness was increased (SMD: 0.80; 95% CI: 0.47- 1.13). Conclusion The aortic root continues to dilate even after surgical repair of TOF. All levels of the aortic root were found to dilate, with the greatest dilatation observed at the levels of the sinus of Valsalva and the ascending aorta. Aortic strain and distensibility are reduced even after corrective surgery, while aortic stiffness is increased. These are the long-term complications of TOF repair and require yearly follow-up. Potentially, methods can be developed to predict complications in the long term by assessing the diameter and elastic properties of the aorta after surgical correction of TOF.Results table Forest plots
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Jha et al. (2025) conducted a meta-analysis in Tetralogy of Fallot (n=2,340). Surgical repair of Tetralogy of Fallot vs. Healthy controls was evaluated on Aortic root dilation at the sinus of Valsalva (SMD 2.547, 95% CI 1.536-3.559). Post-surgical repair of Tetralogy of Fallot is associated with significant aortic root dilatation, particularly at the sinus of Valsalva (SMD 2.547; 95% CI 1.536-3.559), compared to healthy controls.
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