Why the study?
Right ventricular dysfunction is a major cause of morbidity and mortality after total correction of tetralogy of Fallot, and avoiding ventriculotomy via a transatrial/transpulmonary approach may better protect RV structure and function.
Does the transatrial/transpulmonary approach reduce mortality and morbidity compared to the transventricular approach in patients undergoing classical tetralogy of Fallot repair?
Does the transatrial/transpulmonary approach reduce mortality and morbidity compared to the transventricular approach in patients undergoing classical tetralogy of Fallot repair?
The transatrial/transpulmonary approach for tetralogy of Fallot repair is associated with lower mortality and reduced right ventricular dysfunction compared to the transventricular approach.
Should not yet change surgical approach in TOF repair; leaves open need for randomized confirmation of transatrial benefits.
Background: Right ventricular dysfunction is an important cause of morbidity and mortality following total correction of tetralogy of Fallot (TOF). Transatrial/transpulmonary approach avoids ventriculotomy (as opposed to the transventricular approach) which gives maximum protection of the right ventricle structure and function. Objectives: The main objective is to review the results of transatrial/transpulmonary approach and compare it with that of the transventricular approach. Patients and Methods: Forty patients underwent repair of classical TOF were retrospectively studied from January 1, 2015 to January 1, 2018 at Ibn Al-Nafees Teaching Hospital for cardiothoracic surgery in Baghdad, Iraq. We divided the patients into two groups: group A (transventricular approach group) – 22 patients, and Group B (transatrial/transpulmonary approach group) – 18 patients. In this study, we did comparison between these two groups. Results: There were eight operative deaths; the overall mortality was 20%, six patients in Group A (27.27%) versus two patients in Group B (11.11%). Severe right ventricular systolic dysfunction after repair was found in 14 patients (35%), 11 patients in Group A (50%) versus 3 patients in Group B (16.66%). Tachyarrhythmias were seen in 18 patients after repair (45%); 13 patients in Group A (59.09%) versus 5 patients in Group B (27.7%). Conclusion: Transatrial/transpulmonary approach procedure in the TOF surgery is more safe and associated with lower morbidity and mortality than the transventricular approach.
No takes yet. Share an insight, caveat, or question.
Kareem et al. (2020) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: