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Current Strategy of Repair of Tetralogy of Fallot in Children and Adults: Emphasis on a New Technique to Create a Monocusp‐Patch for Reconstruction of the Right Ventricular Outflow Tract
Author(s) -
He GuoWei
Publication year - 2008
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/j.1540-8191.2008.00700.x
Subject(s) - medicine , tetralogy of fallot , ventricular outflow tract , stenosis , pulmonary insufficiency , cardiology , surgery , pulmonary atresia , aortic cross clamp , pulmonary valve , pulmonary valve insufficiency , aortic valve , pulmonary regurgitation , cardiopulmonary bypass , heart disease
Objectives: In older children (>four years) and adults the strategy of repair of tetralogy of Fallot (TOF) should have a low rate of transannular patch to avoid pulmonary insufficiency (PI), and in addition, we developed a new method of reconstruction of the right ventricular outflow tract (RVOT) to reduce PI. Methods: From 2001 through 2005, 74 patients (50 male, 24 female; mean age of 13.6 ± 0.8 years, ranging from four to 34 years) with TOF (67) or double outlet RV (DORV)‐type‐TOF (seven) underwent complete repair. The resection of RVOT stenosis ± pulmonary valvotomy was principally through RA. A new two‐patch technique to create a folded mono‐cusp valve by using autologous pericardium was applied since August 2004. Results: The repair was through RA in 52 patients and through RA + RVOT/PA in 22 patients (18/4). TAPR was performed in 17 patients (23%, eight non‐valved and nine valved). The aortic cross‐clamp time was 130.1 ± 6.8 min in TAPR group and 85.8 ± 4.6 min in non‐TAPR group (p < 0.0001). The operative mortality was 4.0% (3/74) in all and 2.9% (2/67) in TOF patients (due to low output, uncontrollable bleeding, and repeated bleeding from the pulmonary collateral vessels late) and was similar in TAPR or non‐TAPR. The valved patch‐repaired patients had mild PI and good RV function postoperatively up to eight to 12 months. Conclusions: Repair of TOF in older children/adults should include low rate of TAPR of RVOT. If indicated, the new folded monocusp‐patch technique is recommended. It is an effective and simple way to markedly reduce postoperative PI with no additional cost.