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Outcomes Of Palliative Right Ventricle To Pulmonary Artery Connection For Tetralogy Of Fallot With Pulmonary Atresia And MAPCAS
Pablo Alberto Filippa, MD, Pierre-Luc Bernier, MD, Khalil Khalil, MD, Moussa Haidar, MD, Nancy C. Poirier, MD.
CHU Sainte Justine, Montreal, QC, Canada.

Objective(s): Surgical management of infants with Tetralogy of Fallot, pulmonary atresia and major aorto pulmonary artery collaterals (TOF-PA MAPCAS) is challenging with high incidence of early morbidity and mortality. We evaluated the impact of right ventricle to pulmonary artery connection (RVPAC) on mortality, survival, morbidity, PA growth and eligibility for biventricular repair.
Methods: Retrospective study of 15 consecutive infants with TOF-PA MAPCAS treated between 2016 and 2021 palliated with RVPAC. Pre and post-operative echocardiograms, CTs, catheterizations and clinical outcomes were reviewed. Descriptive analysis is provided.
Results: Median age at palliation was 18 days (4 -100). 93.3% received a transannular patch with a survival of 100%. Interstage was approached in the cath-lab with a median of two catheterizations per patient (0-3). Procedures included pulmonary branch stenting, angioplasty and collateral embolization. None needed a surgical unifocalization. Biventricular repair was achieved in 11 patients (73,3%) at a median age of 387 days (96-1263). Nakata index at CT scan went from 70 48,04 mm2/m2 to 237 121,02 mm2/m2 (P = 0.001). No early or late mortality occured. 4 patients (36,6%) needed a cath procedure for branch stenosis. 4 patients (26,6%) are waiting for complete repair.
Conclusions: RVPAC allows excellent growth of the PA tree permitting a biventricular repair in 90 % of the cases without the use of a conduit or unifocalization. This technique appears to be suitable for any type of TOF-PA MAPCAS with confluent native pulmonary arteries with a low incidence of major complications and mortality.


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