| Title: |
Tetralogy of Fallot and abnormal coronary artery: use of a prosthetic conduit is outdated |
| Authors: |
Pontailler, Margaux; Bernard, Chloé; Gaudin, Régis; Moreau de Bellaing, Anne; Mostefa Kara, Mansour; Haydar, Ayman; Barbanti, Claudio; Bonnet, Damien; Vouhé, Pascal; Raisky, Olivier |
| Source: |
European Journal of Cardio-Thoracic Surgery ; volume 56, issue 1, page 94-100 ; ISSN 1010-7940 1873-734X |
| Publisher Information: |
Oxford University Press (OUP) |
| Publication Year: |
2019 |
| Description: |
OBJECTIVES Repair of tetralogy of Fallot (ToF) can be challenging in the presence of an abnormal coronary artery (CA) in 5–12% of cases. The aim of this study was to report our experience with ToF repair without the systematic use of a right ventricle-to-pulmonary artery (RV-PA) conduit. METHODS We conducted a monocentric retrospective study from 2000 to 2016, including 943 patients with ToF who underwent biventricular repair, of whom 8% (n = 76) presented with an abnormal CA. Mean follow-up time was 50 months (1 month–18 years). RESULTS The most frequent CA anomaly was the left descending artery arising from the right CA (n = 47, 61.8%). The median age at repair was 7.7 months (1.8 months–16 years). Thirteen patients (17%) required prior palliation, mostly systemic pulmonary shunts for anoxic spells in the neonatal period. Surgical repair allowed us to preserve the annulus in 40 patients (53%) by combining PA trunk plasty, commissurotomy and infundibulotomy under the abnormal CA. If the annulus had to be opened (n = 35, 46%), a transannular patch was inserted after a vertical incision of the PA trunk and extended obliquely on the RV over the anomalous crossing CA (with an infundibulotomy under the abnormal CA). Three patients (4%) required the insertion of an RV-PA conduit (1 valved tube and 2 RV-PA GORE-TEX tubes with annulus conservation). The early mortality rate was 4% (n = 3); none of the deaths was coronary related. Four patients (5%) required reoperation (2 early and 2 late reoperations) for residual pulmonary stenosis, 3 of whom had annulus preservation during the initial repair. The mean RV/left ventricle (LV) pressure ratio and an RV/LV pressure ratio >2/3 were identified as risk factors for right ventricular outflow tract (RVOT) reinterventions (P = 0.0026, P = 0.0085, respectively), RVOT reoperations (P = 0.0002 for both) and reoperation for RVOT residual stenosis (P = 0.0002, P = 0.0014, respectively). Two patients underwent pulmonary valve replacement. Freedom from late reoperation was ... |
| Document Type: |
article in journal/newspaper |
| Language: |
English |
| DOI: |
10.1093/ejcts/ezz030 |
| Availability: |
https://doi.org/10.1093/ejcts/ezz030; http://academic.oup.com/ejcts/article-pdf/56/1/94/29024790/ezz030.pdf |
| Rights: |
https://academic.oup.com/journals/pages/open_access/funder_policies/chorus/standard_publication_model |
| Accession Number: |
edsbas.A1C8ACD3 |
| Database: |
BASE |