Outcomes After Pulmonary Valve-Preserving Correction Of Tetralogy Of Fallot Using Intraoperative Pulmonary Valve Annulus Balloon Dilatation
Philippe Grieshaber1, Murat Uzdenov2, Christoph Jaschinski1, Raoul Arnold1, Matthias Karck1, Matthias Gorenflo1, Tsvetomir Loukanov1.
1University Heidelberg, Heidelberg, Germany, 2University Freiburg, Freiburg, Germany.
Objective(s):
During Tetralogy of Fallot (TOF) correction, pulmonary valve (PV)-preserving strategies for small PV annuli are needed. Intraoperative balloon valvuloplasty (BVP) of the PV can be used to increase PV annulus size. This study aims to evaluate if PV-preserving TOF correction with intraoperative BVP can achieve comparable results to regular valve-sparing TOF correction in patients with normal-sized PV annuli. Methods:
In this retrospective, single-center study, all patients who underwent PV-preserving TOF correction between 01/2013 and 12/2021 with or without intraoperative PV BVP were compared. Endpoints included: Freedom from PV reinterventions, postoperative course of PV hemodynamics, and survival. Results:
63 patients (BVP group: n=27, control group. n=36) underwent TOF correction at a median age of 6.9±2.5months. Mean baseline PV annulus diameters (BVP: 7.7±1.2mm, control: 8.2±1.8mm; p=0.05) differed significantly between the groups. At follow-up, 40% (control group) and 20% (BVP group) were free of PV regurgitation (p=0.08). At 3 years, 96% survival in both groups (p(log-rank)=0.48) was observed. Freedom from right-sided re-interventions (BVP 73%, Control 75%; p(log-rank)=0.59) were comparable. Conclusions:
In patients with TOF and moderately small PV annuli (Z-score -3 to -2), intraoperative BVP of the PV can be a part of PV repair measures. PV BVP was associated with comparable PV function postoperatively and at follow up compared with patients with larger PV annuli who underwent conventional PV-preserving TOF correction. However, a trend towards more PV regurgitation in the BVP group was observed.
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