Thorac Cardiovasc Surg 2016; 64 - OP108
DOI: 10.1055/s-0036-1571874

Restrictive Enlargement of the Pulmonary Annulus at Surgical Repair of Tetralogy of Fallot: 10-Year Follow-up Study

J. Logoteta 1, L. Dullin 1, J. H. Hansen 1, I. Kristo 1, P. Wegner 1, C. Rickers 1, T. Attmann 2, J. Scheewe 2, H.-H. Kramer 1
  • 1UKSH, Klinik für Angeborene Herzfehler und Kinderkardiologie, Kiel, Germany
  • 2UKSH, Klinik für Herz- und Gefäßchirurgie, Kiel, Germany

Objectives: Since 1996 our center follows a uniform strategy of restrictive enlargement of the pulmonary annulus at surgical repair of tetralogy of Fallot (ToF). A transannular patch (TAP) is only used if the z score of the pulmonary annulus (PV) is < − 4. The rate of TAP was significantly reduced accepting a significantly smaller PV. Whether this strategy leads to reduction of pulmonary insufficiency (PI) and reoperation rate in the long-term has not been studied.

Methods: Ninety-five ToF patients who had their repair between 1996 and 2006 were included in the study. Clinical, echocardiographic, ECG and cardiac MRI data were collected. The cohort was compared with a historic cohort of 110 patients, who had their repair between 1975 and 1996.

Results: Six patients were lost to follow-up. Follow-up since repair was 12.6 (5.9–19.4) years. Twenty-eight patients (31.4%) needed a TAP. Patients were in a good clinical condition (NYHA (½): 78/11) with a mean QRS of 130 ± 21 milliseconds. On echocardiography all patients showed a mild pulmonary stenosis (PS) with a mean Vmax 2.4 ± 0.63 m/s, while 38% showed moderate or severe PI (PI (none/I°/II°/III°: 17/37/32/1). CMR-derived volumes were as follows: EDVi 110.4 ± 20.9 mL/m2, ESVi 55.6 ± 15.8 mL/m2 and EF 48.8 ± 12.1%. Seven patients needed a reoperation for PS (7.9%) and five for PI (5.6%). In three patients, the pulmonary valve had to be replaced (PVR) in the first reoperation, altogether 10 PVRs were performed in five patients. Freedom from reoperation of the PV was 89.3% at 10 years follow-up. In the historic cohort (69%TAP) significantly more patients needed a reoperation for PI (5/89 vs. 20/110, p = 0.005).

Conclusion: The reoperation rate for pulmonary insufficiency is significantly lower in patients with a restrictive enlargement of the pulmonary annulus compared with a historic cohort. To prove whether this result holds true when compared with a cohort of patients operated in the same time period but without following a uniform strategy a control group recruited from the Kompetenznetz Angeborene Herzfehler will be presented.