Does The Type Of Pulmonary Valve Reconstruction For Tetralogy Of Fallot (TOF) Repair Matter In The Long Term?
Amina Jaji, MD1, Emily Pena, PA-C1, Umar Siddiqi2, Luca Vricella, MD3, Chawki El-Zein, MD1, Narutoshi Hibino, MD, PhD3.
1Advocate Children's Hospital - Heart Center, Oak Lawn, IL, USA, 2University of Chicago - Department of surgery, Division of cardiac surgery, Chicago, IL, USA, 3Advocate Children's Hospital & University of Chicago - Department of surgery, Division of cardiac surgery, Oak Lawn, IL, USA.
The management of TOF has changed since MRI-based guidelines for surgical pulmonary valve replacement (PVR) were proposed. We hypothesized that regardless of the type of valve reconstruction at initial repair, long-term RV function (RVF) would not be affected if the PVR is performed according to current guidelines.
Retrospective review from 2011 to 2021 of 40 TOF, DORV, and PA/IVS patients (8-33 yo) who underwent repair, followed by MRI, then initial surgical PVR. The relationship between the type of valve reconstruction, including valve-sparing (VS: N=16), TAP with no valve (NVTAP: N=9), and TAP with valve creation (VTAP: N=17) and RVF at the time of PVR were analyzed.
Median age at time of PVR was younger in VTAP group (NVTAP: 24, VTAP: 9, VS: 12; P<0.05). The years from initial repair to PVR was significantly shorter in VTAP group. There was no significant difference in RVEDVI, RVESVI, and RVEF between groups (Table). In all three groups, the follow up MRI (average of 3.6 years after PVR), demonstrated maintained RVF.
The type of valve reconstruction performed at initial complete repair did not affect RVF at the time of PVR. The complicated valve reconstruction likely shortens the time to PVR. With the advancements of the MRI guidelines for PVR, the type of valve repair technique may no longer be a critical factor.
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