ORIGINAL ARTICLE

Infundibular sparing versus transinfundibular approach to the repair of tetralogy of Fallot

Corresponding Author

Mary K. Olive MD

[email protected]

orcid.org/0000-0001-6095-4701

Department of Pediatrics, Section of Pediatric Cardiology, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan

Correspondence

Mary K. Olive, MD, Department of Pediatrics, Section of Pediatric Cardiology, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan, 1540 East Medical Center Drive, Floor 11, Room 715-Z, Ann Arbor, MI 48109.

Email: [email protected]

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Charles D. Fraser MD,

Charles D. Fraser MD

Department of Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children’s Medical Center, Austin, Texas

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Shelby Kutty MD,

Shelby Kutty MD

Department of Pediatrics, Taussig Congenital Heart Center, Johns Hopkins University, Baltimore, Maryland

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Emmett D. McKenzie MD,

Emmett D. McKenzie MD

Section of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas

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James M. Hammel MD,

James M. Hammel MD

Section of Cardiovascular Surgery, University of Nebraska College of Medicine, Omaha, Nebraska

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Rajesh Krishnamurthy MD,

Rajesh Krishnamurthy MD

Section of Diagnostic Radiology, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio

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Nicolas A. Dodd BM,

Nicolas A. Dodd BM

Section of Pediatric Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas

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Shiraz A. Maskatia MD,

Shiraz A. Maskatia MD

orcid.org/0000-0002-8806-1398

Section of Pediatric Cardiology, Stanford University, Palo Alto, California

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Mary K. Olive MD,

Corresponding Author

Mary K. Olive MD

[email protected]

orcid.org/0000-0001-6095-4701

Department of Pediatrics, Section of Pediatric Cardiology, Congenital Heart Center, C.S. Mott Children’s Hospital, University of Michigan, Ann Arbor, Michigan

Correspondence

Email: [email protected]

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Charles D. Fraser MD,

Charles D. Fraser MD

Department of Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School, Dell Children’s Medical Center, Austin, Texas

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Shelby Kutty MD,

Shelby Kutty MD

Department of Pediatrics, Taussig Congenital Heart Center, Johns Hopkins University, Baltimore, Maryland

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Emmett D. McKenzie MD,

Emmett D. McKenzie MD

Section of Congenital Heart Surgery, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas

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James M. Hammel MD,

James M. Hammel MD

Section of Cardiovascular Surgery, University of Nebraska College of Medicine, Omaha, Nebraska

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Rajesh Krishnamurthy MD,

Rajesh Krishnamurthy MD

Section of Diagnostic Radiology, Nationwide Children’s Hospital, Ohio State University, Columbus, Ohio

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Nicolas A. Dodd BM,

Nicolas A. Dodd BM

Section of Pediatric Radiology, Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas

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Shiraz A. Maskatia MD,

Shiraz A. Maskatia MD

orcid.org/0000-0002-8806-1398

Section of Pediatric Cardiology, Stanford University, Palo Alto, California

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First published: 09 January 2020

https://doi.org/10.1111/chd.12863

Citations: 3

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Abstract

Introduction

The right ventricular infundibular sparing approach (RVIS) to the repair of tetralogy of Fallot (TOF) avoids a full-thickness ventricular incision, typically utilized in the transinfundibular (TI) method.

Methods

We performed a retrospective, age-matched cohort study of patients who underwent RVIS at Texas Children’s Hospital or TI at Children’s Hospital Medical Center in Nebraska and subsequently underwent cardiac magnetic resonance imaging (CMR). We compared right ventricular end-diastolic and systolic volumes indexed to body surface area (RVEDVi and RVESVi) and right ventricular ejection fraction (RVEF) as primary endpoints. Secondary endpoints were indexed left ventricular diastolic and systolic volume (LVEDVi and LVESVi), left ventricular ejection fraction (LVEF), right ventricular (RV) sinus ejection fraction (EF) and RV outflow tract EF (RVOT EF).

Results

Seventy-nine patients were included in the analysis; 40 underwent RVIS and 39 underwent TI repair. None of the patients in the TI repair group had an initial palliation with a systemic to pulmonary arterial shunt compared to seven (18%) in the RVIS group (P < .01). There was no appreciable difference in RVEDVi (122 ± 29 cc/m² vs 130 ± 29 cc/m², P = .59) or pulmonary regurgitant fraction (40 ± 13 vs 37 ± 18, P = .29) between the RVIS and TI groups. Compared to the TI group, the RVIS group had higher RVEF (54 ± 6% vs 44 ± 9%, P < .01), lower RVESV (57 ± 17 cc/m² vs 67 ± 25 cc/m², P = .03), higher LVEF (61 ± 11% vs 54 ± 8%, P < .01), higher RVOT EF (47 ± 12% vs 41 ± 11%, P = .03), and higher RV sinus EF (56 ± 5% vs 49 ± 6%, P < .01)

Conclusions

In this selected cohort, patients who underwent RVIS repair for TOF had higher right and left ventricular ejection fraction compared to those who underwent TI repair.

CONFLICT OF INTEREST

There are no conflicts of interest to disclose.

REFERENCES

1d'Udekem Y, Galati JC, Rolley GJ, et al. Low risk of pulmonary valve implantation after a policy of transatrial repair of tetralogy of Fallot delayed beyond the neonatal period: the Melbourne experience over 25 years. J Am Coll Cardiol. 2014; 63: 563-568.
10.1016/j.jacc.2013.10.011
PubMed Web of Science® Google Scholar
2Kirsch RE, Glatz AC, Gaynor JW, et al. Results of elective repair at 6 months or younger in 277 patients with tetralogy of Fallot: a 14-year experience at a single center. J Thorac Cardiovasc Surg. 2014; 147: 713-717.
10.1016/j.jtcvs.2013.03.033
PubMed Web of Science® Google Scholar
3Geva T, Sandweiss BM, Gauvreau K, Lock JE, Powell AJ. Factors associated with impaired clinical status in long-term survivors of tetralogy of Fallot repair evaluated by magnetic resonance imaging. J Am Coll Cardiol. 2004; 43: 1068-1074.
10.1016/j.jacc.2003.10.045
PubMed Web of Science® Google Scholar
4Knauth AL, Gauvreau K, Powell AJ, et al. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart. 2008; 94: 211-216.
10.1136/hrt.2006.104745
CAS PubMed Web of Science® Google Scholar
5Valente AM, Gauvreau K, Assenza GE, et al. Contemporary predictors of death and sustained ventricular tachycardia in patients with repaired tetralogy of Fallot enrolled in the INDICATOR cohort. Heart. 2014; 100: 247-253.
10.1136/heartjnl-2013-304958
PubMed Web of Science® Google Scholar
6Maskatia SA, Spinner JA, Nutting AC, Slesnick TC, Krishnamurthy R, Morris SA. Impact of obesity on ventricular size and function in children, adolescents and adults with tetralogy of fallot after initial repair. Am J Cardiol. 2013; 112(4): 594-598.
10.1016/j.amjcard.2013.04.030
PubMed Web of Science® Google Scholar
7Ortega M, Triedman JK, Geva T, Harrild DM. Relation of left ventricular dyssynchrony measured by cardiac magnetic resonance tissue tracking in repaired tetralogy of fallot to ventricular tachycardia and death. Am J Cardiol. 2011; 107: 1535-1540.
10.1016/j.amjcard.2011.01.032
PubMed Web of Science® Google Scholar
8Sarikouch S, Boethig D, Peters B, et al. Poorer right ventricular systolic function and exercise capacity in women after repair of tetralogy of fallot: a sex comparison of standard deviation scores based on sex-specific reference values in healthy control subjects. Circ Cardiovasc Imaging. 2013; 6: 924-933.
10.1161/CIRCIMAGING.112.000195
PubMed Web of Science® Google Scholar
9Bove T, Bouchez S, De Hert S, et al. Acute and chronic effects of dysfunction of right ventricular outflow tract components on right ventricular performance in a porcine model: implications for primary repair of tetralogy of fallot. J Am Coll Cardiol. 2012; 60: 64-71.
10.1016/j.jacc.2012.03.035
PubMed Web of Science® Google Scholar
10Bacha EA, Scheule AM, Zurakowski D, et al. Long-term results after early primary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2001; 122: 154-161.
10.1067/mtc.2001.115156
CAS PubMed Web of Science® Google Scholar
11Di Donato RM, Jonas RA, Lang P, Rome JJ, Mayer JE Jr, Castaneda AR. Neonatal repair of tetralogy of Fallot with and without pulmonary atresia. J Thorac Cardiovasc Surg. 1991; 101: 126-137.
10.1016/S0022-5223(19)36802-3
CAS PubMed Web of Science® Google Scholar
12Morales DL, Zafar F, Heinle JS, et al. Right ventricular infundibulum sparing (RVIS) tetralogy of fallot repair: a review of over 300 patients. Ann Surg. 2009; 250: 611-617.
PubMed Web of Science® Google Scholar
13McKenzie ED, Maskatia SA, Mery C. Surgical management of tetralogy of fallot: in defense of the infundibulum. Semin Thorac Cardiovasc Surg. 2013; 25: 206-212.
10.1053/j.semtcvs.2013.10.003
PubMed Google Scholar
14Chung T. Assessment of cardiovascular anatomy in patients with congenital heart disease by magnetic resonance imaging. Pediatr Cardiol. 2000; 21: 18-26.
10.1007/s002469910004
CAS PubMed Web of Science® Google Scholar
15O'Meagher S, Ganigara M, Munoz P, et al. Right ventricular outflow tract enlargement prior to pulmonary valve replacement is associated with poorer structural and functional outcomes, in adults with repaired Tetralogy of Fallot. Heart Lung Circ. 2014; 23: 482-488.
10.1016/j.hlc.2013.11.009
PubMed Web of Science® Google Scholar
16Bove T, Vandekerckhove K, Devos D, et al. Functional analysis of the anatomical right ventricular components: should assessment of right ventricular function after repair of tetralogy of Fallot be refined? Eur J Cardiothorac Surg. 2014; 45: e6-e12.
10.1093/ejcts/ezt505
PubMed Web of Science® Google Scholar
17Bodhey NK, Beerbaum P, Sarikouch S, et al. Functional analysis of the components of the right ventricle in the setting of tetralogy of Fallot. Circ Cardiovasc Imaging. 2008; 1: 141-147.
10.1161/CIRCIMAGING.108.783795
PubMed Web of Science® Google Scholar
18Mercer-Rosa L, Yang W, Kutty S, Rychik J, Fogel M, Goldmuntz E. Quantifying pulmonary regurgitation and right ventricular function in surgically repaired tetralogy of Fallot: a comparative analysis of echocardiography and magnetic resonance imaging. Circ Cardiovasc Imaging. 2012; 5: 637-643.
10.1161/CIRCIMAGING.112.972588
PubMed Web of Science® Google Scholar
19Geva T. Repaired tetralogy of Fallot: the roles of cardiovascular magnetic resonance in evaluating pathophysiology and for pulmonary valve replacement decision support. J Cardiovasc Magn Reson. 2011; 13: 9.
10.1186/1532-429X-13-9
PubMed Web of Science® Google Scholar
20Lee C, Lee CH, Kwak JG, et al. Factors associated with right ventricular dilatation and dysfunction in patients with chronic pulmonary regurgitation after repair of tetralogy of Fallot: analysis of magnetic resonance imaging data from 218 patients. J Thorac Cardiovasc Surg. 2014; 148: 2589-2595.
10.1016/j.jtcvs.2014.07.051
PubMed Web of Science® Google Scholar
21Lee C, Lee CH, Kwak JG, et al. Does limited right ventriculotomy prevent right ventricular dilatation and dysfunction in patients who undergo transannular repair of tetralogy of Fallot? Matched comparison of magnetic resonance imaging parameters with conventional right ventriculotomy long-term after repair. J Thorac Cardiovasc Surg. 2014; 147: 889-895.
10.1016/j.jtcvs.2013.11.019
PubMed Web of Science® Google Scholar
22Uebing A, Gibson DG, Babu-Narayan SV, et al. Right ventricular mechanics and QRS duration in patients with repaired tetralogy of Fallot: implications of infundibular disease. Circulation. 2007; 116: 1532-1539.
10.1161/CIRCULATIONAHA.107.688770
PubMed Web of Science® Google Scholar
23Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot: a multicentre study. Lancet. 2000; 356: 975-981.
10.1016/S0140-6736(00)02714-8
CAS PubMed Web of Science® Google Scholar
24Davlouros PA, Kilner PJ, Hornung TS, et al. Right ventricular function in adults with repaired tetralogy of Fallot assessed with cardiovascular magnetic resonance imaging: detrimental role of right ventricular outflow aneurysms or akinesia and adverse right-to-left ventricular interaction. J Am Coll Cardiol. 2002; 40: 2044-2052.
10.1016/S0735-1097(02)02566-4
PubMed Web of Science® Google Scholar
25Wald RM, Haber I, Wald R, Valente AM, Powell AJ, Geva T. Effects of regional dysfunction and late gadolinium enhancement on global right ventricular function and exercise capacity in patients with repaired tetralogy of Fallot. Circulation. 2009; 119: 1370-1377.
10.1161/CIRCULATIONAHA.108.816546
PubMed Web of Science® Google Scholar
26Latus H, Hachmann P, Gummel K, et al. Impact of residual right ventricular outflow tract obstruction on biventricular strain and synchrony in patients after repair of tetralogy of Fallot: a cardiac magnetic resonance feature tracking study. Eur J Cardiothorac Surg. 2015; 48: 83-90.
10.1093/ejcts/ezu396
PubMed Web of Science® Google Scholar
27Bove T, Vandekerckhove K, Bouchez S, Wouters P, Somers P, Van Nooten G. Role of myocardial hypertrophy on acute and chronic right ventricular performance in relation to chronic volume overload in a porcine model: relevance for the surgical management of tetralogy of Fallot. J Thorac Cardiovasc Surg. 2014; 147: 1956-1965.
10.1016/j.jtcvs.2013.10.026
PubMed Web of Science® Google Scholar
28Marelli A, Gauvreau K, Landzberg M, Jenkins K. Sex differences in mortality in children undergoing congenital heart disease surgery: a United States population-based study. Circulation. 2010; 122: S234-S240.
10.1161/CIRCULATIONAHA.109.928325
PubMed Web of Science® Google Scholar

Citing Literature

Volume14, Issue6

November/December 2019

Pages 1149-1156

Infundibular sparing versus transinfundibular approach to the repair of tetralogy of Fallot

Abstract

Introduction

Methods

Results

Conclusions

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Information

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Infundibular sparing versus transinfundibular approach to the repair of tetralogy of Fallot

Abstract

Introduction

Methods

Results

Conclusions

CONFLICT OF INTEREST

REFERENCES

Citing Literature

References

Related

Information