Amount Of Aortopulmonary Collaterals Predicts In-hospital Outcome In Tetralogy Of Fallot With Pulmonary Stenosis
YiBing Fang, Yue Wang, Ziqing Xiong, Xiao Li, Yunfei Ling, Yabo Wang, Changping Gan, Ke Lin, Qi An, Shuhua Luo.
Sichuan University West China Hospital, chengdu, China.
Objective(s): To characterize the anatomy of aortopulmonary collaterals(APC) in TOF/PS, and to determine whether total indexed APC cross-section area(APC-CSA) per patient measured by preoperative CT predicts in-hospital outcome.
Methods: The retrospective single-center study includes 135(2015-2019) patients who underwent one-stage repair. Preoperative CT, echocardiography, and clinical outcomes were reviewed. The cutoff-value of indexed APC-CSA was identified by Receiver-Operating-Characteristic curve. Logistic regression was used for predictors analysis.
Results: The median age and body weight were 19.7(10.1-89.7) months and 10(8.3-18) kg. In a total of 337 APC were detected with only one had severe proximal stenosis. There was a strong correlation between mean APC diameter per patient and age(r=0.70, p=0.000). APC was left alone without interventions. Based on the cutoff-value, patients with APC-CSA≥3.0mm2/m2(n=71) experienced significant more occurrence of composite-outcome including death, arrest, renal/hepatic failure, lactic acidosis or extracorporeal-membrane-oxygenation use(p=0.007), grater((p=0.008) and longer(p=0.01) use of inotropic-support, prolonged chest tube insertion(p=0.013), longer ventilation(p=0.042), ICU(p=0.014) and hospital(p=0.027)duration. In-hospital mortality was similar between patients with large(≥3. 0mm2/m2) and small amount(<3. 0mm2/m2) of APC(2.8%vs.1.6%,p=0.642). No reintervention and death occurred in the follow-up with median duration of 24.4(11-36.6) months.Multivariable analysis showed Nakata index(p=0.05) and the large amount of APC(p=0.02) were the predictors independently associated with composite-outcome.
Conclusions: In TOF/PS, APC is likely to be dilated bronchial arteries. CT-derived preoperative indexed APC-CSA are as important as pulmonary artery anatomic parameters to predict the in-hospital outcome.
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