Key result
Transatrial TOF repair yields similar RV function to transventricular but links to fewer pulmonary valve replacements.
Why the study?
Does a transatrial approach compared to a transventricular approach improve long-term right ventricular function and clinical outcomes in patients undergoing repair of tetralogy of Fallot?
Cohort (n=79)
Yes
Does a transatrial approach compared to a transventricular approach improve long-term right ventricular function and clinical outcomes in patients undergoing repair of tetralogy of Fallot?
The transatrial approach for tetralogy of Fallot repair yields similar long-term right ventricular function to the transventricular approach but is associated with a lower rate of late pulmonary valve replacement.
Supports transatrial repair consideration in tetralogy of Fallot; leaves open randomized confirmation of fewer late pulmonary valve replacements.
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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Padalino et al. (2017) conducted a cohort in Tetralogy of Fallot (n=79). Transatrial (TA) approach vs. Transventricular (TV) approach was evaluated on Freedom from reintervention, right ventricular volumes, function, and pulmonary regurgitation. Transatrial repair of tetralogy of Fallot yielded similar right ventricular function to transventricular repair, but was associated with less frequent pulmonary valve replacement (P=0.033).
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