The Impact of Native Fallot Anatomy on Future Therapeutic Requirements and Outcomes at Follow-up
Background: In patients with repaired Fallot, subsequent surgical or interventional procedures and adverse cardiac events are frequent. We aimed to evaluate the impact of a simple pre-operative anatomic classification based on the size of the pulmonary valve annulus and branches on future therapeutic requirements and outcomes.
Method This is a single-center retrospective analysis of patients operated for Fallot before the age of 2 years, from January 1990. Pre-operative anatomy, surgical and interventional procedures and adverse events were extrapolated from clinical records.
Results: Among the 312 patients, a description of the PV and PAs native anatomy was known in 239 patients (male:147, 61.5%), which were divided in the following 3 groups: group 1 (65 patients) with normal size of both pulmonary valve and pulmonary artery branches; group 2 (108 patients) with pulmonary valve hypoplasia but normal size pulmonary artery branches; group 3 (66 patients) with concomitant hypoplasia of the pulmonary valve and pulmonary artery branches. During the 12.7 years (IQR 6.7-17) follow-up time, 23% of patients required at least one surgical or interventional procedure. At Kaplan-Meier analysis, there was a significant difference in requirement of future surgical or interventional procedures among the 3 groups (p<0,001). At multivariate Cox regression analysis, hypoplasia of pulmonary valve and artery branches was an independent predictor of subsequent procedures (HR:3.1,CI:1.06-9.1, p=0.03).
Conclusion native anatomy in Tetralogy of Fallot patients affects surgical strategy and follow-up. It would be therefore advisable to tailor patient’s counseling and follow-up according to native anatomy, rather than following a standardized protocol.
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Posted 30 Dec, 2020
Invitations sent on 28 Dec, 2020
On 26 Dec, 2020
On 26 Dec, 2020
On 26 Dec, 2020
On 22 Dec, 2020
The Impact of Native Fallot Anatomy on Future Therapeutic Requirements and Outcomes at Follow-up
Posted 30 Dec, 2020
Invitations sent on 28 Dec, 2020
On 26 Dec, 2020
On 26 Dec, 2020
On 26 Dec, 2020
On 22 Dec, 2020
Background: In patients with repaired Fallot, subsequent surgical or interventional procedures and adverse cardiac events are frequent. We aimed to evaluate the impact of a simple pre-operative anatomic classification based on the size of the pulmonary valve annulus and branches on future therapeutic requirements and outcomes.
Method This is a single-center retrospective analysis of patients operated for Fallot before the age of 2 years, from January 1990. Pre-operative anatomy, surgical and interventional procedures and adverse events were extrapolated from clinical records.
Results: Among the 312 patients, a description of the PV and PAs native anatomy was known in 239 patients (male:147, 61.5%), which were divided in the following 3 groups: group 1 (65 patients) with normal size of both pulmonary valve and pulmonary artery branches; group 2 (108 patients) with pulmonary valve hypoplasia but normal size pulmonary artery branches; group 3 (66 patients) with concomitant hypoplasia of the pulmonary valve and pulmonary artery branches. During the 12.7 years (IQR 6.7-17) follow-up time, 23% of patients required at least one surgical or interventional procedure. At Kaplan-Meier analysis, there was a significant difference in requirement of future surgical or interventional procedures among the 3 groups (p<0,001). At multivariate Cox regression analysis, hypoplasia of pulmonary valve and artery branches was an independent predictor of subsequent procedures (HR:3.1,CI:1.06-9.1, p=0.03).
Conclusion native anatomy in Tetralogy of Fallot patients affects surgical strategy and follow-up. It would be therefore advisable to tailor patient’s counseling and follow-up according to native anatomy, rather than following a standardized protocol.
Figure 1
Figure 2
Figure 3