Influence of Pulmonary Valve Function Preservation Technique for Tetralogy of Fallot Repair on Right Ventricular Performance in Children

Abstract

Background: Right ventricular (RV) ejection fraction may remain normal or even high despite significant impairment of RV myocardial performance in cases of total repair for tetralogy of Fallot (TOF). The aim of this study is to evaluate the influence of pulmonary valve function preservation (PVFP) versus monocuspid transannular patch augmentation (MTAPA) surgical strategies for Fallot repair on postoperative RV performance. Methods: This retrospective study enrolled all patients (N = 480) who had TOF repaired at our center over a period of 7 years (March 2012 to January 2019). Group I included 377 patients (78.5%) who underwent TOF repair with MTAPA, and group II included 103 patients (21.5%) who underwent TOF repair with PVFP, which included all patients with pulmonary valve sparing with limited sub- or supravalvular patch. Patients’ preoperative and postoperative echocardiography and other parameters (ventilation time, intensive care unit [ICU] stay duration, and RV myocardial performance index [RVMPI]) were recorded to evaluate RV function. Results: We observed a significant statistical difference in the postoperative course between groups I and II, with excellent midterm outcomes for group II. A remarkable significant improvement of RVMPI took place in group II versus group I (P < .0001), as well as a significant decline in pulmonary regurgitation progression (P < .0001). The immediate postoperative RVMPI in group I (0.79 ± 0.63) versus that in group II (0.36 ± 0.17) was significantly higher (P < .0001), as was the late postoperative RVMPI (group I, 0.64 ± 0.25; group II, 0.49 ± 0.17; P < 0001). The postoperative RV outflow tract was decreased in group II versus group I. Group II had a significantly shorter duration on mechanical ventilation and in the ICU and less need for inotropes. Conclusion: We conclude that TOF repair patients have excellent RV myocardial performance with the PVFP surgical strategy in comparison with MTAPA.