Key result
RVOT stenting in severe ToF neonates linked to a ~19% increase in oxygen saturation.
Why the study?
Neonates with severe Tetralogy of Fallot require palliation to augment pulmonary blood flow, but optimal palliation strategies including RVOT stenting need further evaluation.
Does RVOT stenting improve oxygen saturation and promote pulmonary artery growth in neonates with severe Tetralogy of Fallot?
Observational (n=4)
No
Does RVOT stenting improve oxygen saturation and promote pulmonary artery growth in neonates with severe Tetralogy of Fallot?
Absolute Event Rate: 82% vs 63%
p-value: p=0.018
RVOT stenting is a feasible and effective palliation strategy for neonates with severe TOF, improving oxygenation and promoting pulmonary artery growth prior to complete repair.
RVOT stenting appears feasible for pulmonary flow augmentation in neonates with severe TOF; leaves open comparative effectiveness versus BTS or ductal stenting.
Background: Neonates with Tetralogy of Fallot (TOF) might be prostaglandin dependent and cannot be discharged from the hospital except after complete correction or palliation. Palliation could be achieved by modified Blalock-Taussig Shunt (BTS), ductal stenting, or right ventricular outflow tract (RVOT) stenting. Objective: The objective of this study was to present our experience of palliating neonates with severe TOF who require augmentation of the pulmonary blood flow by RVOT stenting. Methods: This study was conducted on a series of patients who had RVOT stenting in PSCC-Qassim, Saudi Arabia, from August 2016 till December 2019. Cases that had RVOT stenting are included. The patient's clinical data, echocardiography, cardiac catheterization, and follow-up data were recorded. Data were analyzed using The Microsoft Excel data analysis tool. Results: During the study period, four consecutive patients with a diagnosis of TOF with significant cyanosis underwent RVOT stenting. The mean age and weight were 2.8±1.7 days and 2.9±0.1 kg respectively. All were on prostaglandin infusion before the intervention. The mean saturation before and after RVOT stenting was 63% (±11%) and 82% (±4%) respectively (p = 0.018). One patient required RVOT stent dilatation after 4 months. All patients are alive and had complete TOF repair at a median age of 6.5 months (range 6 to 12 months). The median follow-up period is 13 months. The median branch PAs diameter and Z-score before RVOT stenting and immediately before complete TOF repair were 2.8 mm (Z score: -2.5) and 5.5 mm (Z score: -0.5 to -1.16) respectively (p = 0.001). Conclusion: RVOT stenting is a reasonable alternative palliation for patients with severe TOF. The technique of stent deployment in the RVOT is challenging and requires pre-intervention planning and discussion. Using soft catheters, coronary wires, and the premounted coronary stents facilitate crossing of the RVOT and pulmonary valve and then stent deploymen
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Ali A. Alakhfash (2022) conducted an observational in Severe Tetralogy of Fallot (n=4). Right ventricular outflow tract (RVOT) stenting vs. Pre-intervention baseline was evaluated on Mean oxygen saturation (p=0.018). Right ventricular outflow tract stenting in neonates with severe Tetralogy of Fallot significantly increased mean oxygen saturation from 63% to 82% (p=0.018).
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