Outcomes after Pulmonary Valve-Preserving Correction of Tetralogy of Fallot Using Intraoperative Pulmonary Valve Annulus Balloon Dilatation

Background: In tetralogy of Fallot (TOF) correction, it is preferred to achieve a pulmonary valve (PV)-preserving correction. For small PV annuli, a transannular patch (TAP) can be used but is associated with increased rates of reoperations. Therefore, PV-preserving strategies for small PV annuli are needed. A strategy to increase PV annulus size during TOF correction is intraoperative balloon valvuloplasty (BVP) of the PV. This study aims to evaluate if TOF correction with intraoperative BVP for patients with small PV annuli can achieve comparable results to regular valve-sparing TOF correction in patients with normal-sized PV annuli.

Method: In this retrospective, single-center study, all patients who underwent PV-preserving TOF correction between January 2013 and December 2021 with (BVP group) or without (control group) intraoperative PV BVP ± other RVOT, PV, and pulmonary artery repair techniques were included. The BVP group and control group were compared. In our institution, intraoperative BVP was generally considered for moderately small PV annuli (Z-score: −3 to −2).

Results: Sixty-three patients (BVP n = 27, control n = 36) who underwent TOF correction at a median age of 6.9 ± 2.5 months and body weight of 6.5 ± 1.2 kg were included. The follow-up was conducted at a median of 736 days (BVP) and 905 days (control). The baseline PV annulus diameters (BVP: 7.7 ± 1.2 mm, control: 8.2 ± 1.8 mm; p = 0.05) and PV Z-scores (BVP: −2.2 ± 0.3, control: −1.7 ± 0.5; p = 0.002) differed significantly between the groups. The preoperative PV peak velocity was higher in the BVP group compared with the control group (4.7 ± 0.5 m/s vs. 4.3 ± 0.4 m/s; p = 0.002). On postoperative day 5 (BVP: 2.6 ± 0.4 m/s, control: 2.3 ± 0.5 ms, p = 0.4) and at follow-up (BVP: 2.4 ± 0.4 m/s, control: 3.6 ± 0.4 m/s, p = 0.10), the peak velocities did not differ significantly between the groups. At follow-up, 40% of patients in the control group compared with 20% of patients in the BVP group were free of PV regurgitation (p = 0.08). Moderate or severe PV regurgitation was observed in 13% of patients in both groups. Survival was 96% in both groups at 3 years (p (log-rank) = 0.48). Freedom from reinterventions (BVP 73%, control 75%; p (log-rank) = 0.59) at 3 years was comparable.

Conclusion: In patients with TOF and moderately small PV annuli (Z-score −3 to −2), intraoperative PV BVP is feasible. PV BVP is 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 toward more PV regurgitation in the BVP group was observed without increased need for reinterventions in the midterm.

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Artikel online veröffentlicht:
28. Januar 2023