Key result
Larger MSCT pulmonary valve diameter z-score is linked to ~55% lower odds of transannular patch use.
Why the study?
The pulmonary valve annulus diameter z-score is commonly used to predict transannular patch insertion during Tetralogy of Fallot repair, which carries a risk of long-term pulmonary insufficiency. However, no preoperative z-score threshold had been established in Indonesia to guide this critical surgical decision.
Does the preoperative cardiac MSCT-derived pulmonary valve annulus diameter z-score predict the need for transannular patch insertion in pediatric patients undergoing primary Tetralogy of Fallot repair?
Cross-Sectional (n=101)
No
Does the preoperative cardiac MSCT-derived pulmonary valve annulus diameter z-score predict the need for transannular patch insertion in pediatric patients undergoing primary Tetralogy of Fallot repair?
Preoperative cardiac MSCT-derived pulmonary valve annulus minimum diameter z-score (with an optimal cutoff of -1.6) independently predicts the need for transannular patch insertion during Tetralogy of Fallot repair, aiding preoperative surgical planning.
May guide preoperative planning in tetralogy of Fallot repair; leaves open need for prospective validation.
Background: The use of a Transannular Patch (TAP) in the surgical repair of Tetralogy of Fallot (TOF) can improve Right Ventricular Outflow Tract (RVOT) flow but may increase the risk of long-term pulmonary insufficiency. Therefore, the decision to use TAP is critical. The Pulmonary Valve Annulus (PVA) diameter z-score is commonly used to predict TAP insertion; however, no z-score threshold has been established in Indonesia. This study sought to investigate whether the preoperative z-score of PVA diameter predicts the use of TAP during TOF repair surgery. Methods: This cross-sectional study utilized data from 101 TOF patients who underwent TOF repair at National Cardiovascular Center Harapan Kita between January 2023 and December 2024. Patients were divided into two groups based on TAP usage (Yes: n = 65; No: n = 36). Preoperative PVA diameter was obtained from cardiac Multislice Computed Tomography (MSCT). Multivariate logistic regression was performed, and Receiver Operating Characteristic (ROC) curve analyses were conducted to determine the optimal cutoff thresholds. Results: Multivariate analysis showed the z-score of PVA minimal diameter was significantly associated with TAP usage (Odds Ratio [OR] 0.450, 95% Confidence Interval [CI] 0.297 to 0.683, P < 0.001). A preoperative minimum PVA diameter z-score cut-off of -1.6 yielded a sensitivity of 75.4% and a specificity of 61.1%. Conclusions: The z-score of the PVA diameter may serve as a useful predictor in planning an appropriate surgical strategy in ToF repair, particularly regarding the decision to use a TAP.
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Busro et al. (2026) conducted a cross-sectional in Tetralogy of Fallot (n=101). Preoperative Pulmonary Valve Annulus (PVA) minimum diameter z-score (by MSCT) vs. Non-Transannular Patch (Non-TAP) repair was evaluated on Transannular Patch (TAP) insertion during Tetralogy of Fallot repair (OR 0.450, 95% CI 0.297-0.683, p=<0.001). Preoperative MSCT-derived PVA minimum diameter z-score significantly predicted transannular patch use in Tetralogy of Fallot repair (OR 0.450, 95% CI 0.297-0.683; P<0.001).
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