The type of initial valve reconstruction in Tetralogy of Fallot patients did not affect right ventricular function at the time of pulmonary valve replacement when guided by MRI.
Does the type of initial valve reconstruction technique affect right ventricular size and function at the time of pulmonary valve replacement in patients with repaired Tetralogy of Fallot?
The type of initial valve reconstruction in Tetralogy of Fallot does not significantly affect right ventricular size and function at the time of pulmonary valve replacement when performed according to CMR guidelines.
Absolute Event Rate: 0% vs 0%
Background Most surgically repaired or reconstructed valves for Tetralogy of Fallot (TOF) deteriorate over time. The long‐term management of TOF has changed since cardiac magnetic resonance (CMR) imaging‐based guidelines for surgical pulmonary valve replacement (PVR) were proposed in 2007. We hypothesized that the type of valve reconstruction at initial TOF repair does not affect long‐term right ventricular failure (RVF), as long as PVR is performed at appropriate timing according to guidelines. Methods A retrospective chart review was conducted from January 2011 to June 2021 of 42 TOF, double‐outlet right ventricle (DORV), and pulmonary atresia with intact interventricular septum (PAIS) patients (5–53 years old) who underwent PVR following initial complete repair. The right ventricular (RV) size and function, on CMR, at the time of PVR were compared between types of initial complete repairs including valve‐sparing (VS: N = 16), transannular patch (TAP) with no valve creation (NVTAP: N = 9), and TAP with valve creation (VTAP: N = 17). Results Median age (years) at time of PVR was significantly younger in the VTAP group ( p < 0.03). Years from initial TOF repair to initial surgical PVR were significantly shorter in the VTAP group (NVTAP: 21 ± 14, VTAP: 9 ± 3, VS: 12 ± 6). There were no significant differences in indexed right ventricular end‐diastolic volume (RVEDVi), indexed right ventricular end‐systolic volume (RVESVi), and right ventricular ejection fraction (RVEF) between groups. There was no significant correlation between the time from initial repair to PVR and RVEDVi ( R = 0.11, p = 0.5), RVESVi ( R = 0.11, p = 0.5), or RVEF ( R = −0.17, p = 0.29). In all three groups, the follow‐up MRI (average of 3.6 years after PVR) demonstrated maintained RVF. Conclusions The type of valve reconstruction performed at initial complete repair for TOF did not affect RVF at the time of PVR. The type of initial valve repair technique may no longer be a critical factor, as long as the PVR is performed per MRI guidelines.
Paluri et al. (Thu,) reported a other. The type of initial valve reconstruction in Tetralogy of Fallot patients did not affect right ventricular function at the time of pulmonary valve replacement when guided by MRI.