Key result
Transatrial tetralogy of Fallot repair yields superior or equivalent RV outcomes versus transventricular repair.
Why the study?
Whether the transatrial-transpulmonary approach provides superior outcomes compared with the transventricular approach in non-neonatal patients undergoing tetralogy of Fallot repair was uncertain.
Does the transatrial-transpulmonary approach improve outcomes compared with the transventricular approach in non-neonatal patients undergoing tetralogy of Fallot repair?
Systematic Review
Does the transatrial-transpulmonary approach improve outcomes compared with the transventricular approach in non-neonatal patients undergoing tetralogy of Fallot repair?
The transatrial-transpulmonary approach for tetralogy of Fallot repair generally provides superior or equivalent long-term right ventricular and clinical outcomes compared to the transventricular approach, except potentially in infants.
Supports transatrial repair preference in non-neonatal TOF; confirms long-term RV and arrhythmia benefits versus transventricular approach.
A best evidence topic in cardiac surgery was written according to a structured protocol. The question addressed was whether the transatrial-transpulmonary approach to tetralogy of Fallot repair in non-neonatal patients provides superior outcomes compared with the transventricular approach. Altogether, 175 papers were found using the reported search, of which 11 represented the best evidence to answer the clinical question. Two randomized controlled trials (RCTs) and 3 observational studies showed that the transatrial approach resulted in better preservation of right ventricular (RV) function, whereas 4 observational studies showed no significant difference. Three observational studies showed better attenuation of RV dilatation, whereas 3 showed no difference. One RCT and 2 observational studies showed lower incidence of postoperative ventricular arrhythmias, while 1 RCT and 4 observational studies showed no difference. Two observational studies demonstrated greater freedom from reoperation, 1 RCT and 2 observational studies showed no difference, while 1 retrospective study observed a higher incidence of residual RV outflow tract obstruction and lower freedom from reoperation in infants. Two observational studies reported lower risk of requiring pulmonary valve replacement, whereas 2 reported no difference. Three observational studies reported superior exercise capacity, while 1 reported no difference. No difference in long-term survival was demonstrated. The results presented suggest that transatrial repair of tetralogy of Fallot confers superior or equivalent outcomes in terms of preservation of RV function and volume, ventricular arrhythmias, need for pulmonary valve replacement, and exercise capacity compared with transventricular repair. However, the incidence of residual RV outflow tract obstruction may be higher in infants undergoing transatrial repair.
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Ye et al. (2019) conducted a systematic review in Tetralogy of Fallot. Transatrial-transpulmonary approach vs. Transventricular approach was evaluated on Right ventricular function, ventricular arrhythmias, need for pulmonary valve replacement, and exercise capacity. Transatrial repair of tetralogy of Fallot confers superior or equivalent outcomes in preservation of RV function, ventricular arrhythmias, and exercise capacity compared with transventricular repair.
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