Abstract 13992: A Dacron Limited Transannular Patch Prevents Progressive Pulmonary Valve Annulus Dilation: Results of Serial Early, Intermediate, and Long-Term Follow-Up
Michael F Swartz, Gabrielle Orie, Shuichi Yoshitake, Nader A Atallah-Yunes, Jill Cholette, George Alfieris- Physiology (medical)
- Cardiology and Cardiovascular Medicine
Objective: The repair of tetralogy of Fallot (ToF) using a transannular patch can result in progressive pulmonary valve annulus (PVA) dilation, preventing the option of a future catheter-based pulmonary valve replacement and requiring early reoperation. A rigid Dacron limited transannular patch (LTAP) that nominally expands the PVA may prevent long-term annular dilation and reoperation.
Hypothesis: Infants following a LTAP would have similar rates of PVA growth compared to infants requiring only a subvalvar (SV) repair.
Methods: Infants < 1 year between 1998-2018 requiring a SV or LTAP ToF repair were divided into two groups based on the surgical approach. Pre-operative and serial follow-up echocardiograms quantified the PVA diameter and corresponding Z-Score at 5, 10, and 15 years. Multivariate analysis examined the risk factors for reoperation.
Results: From 232 ToF repairs (LTAP-94; SV-138), the LTAP group was significantly younger (103±53 vs. 138±67 days; p<0.001) and had a smaller pulmonary valve annulus Z-Score (-2.9±1.4 vs. -0.8±1.4; p<0.001) at the time of repair. Over a follow-up of 10.4±5.9 years, PVA growth was linear in both groups (Figure 1). The PVA diameter was similar in both groups at 5 and 10 years but was significantly smaller within the LTAP group at 15 years. The PVA diameter Z-scores remained similar at 5, 10, and 15 years in both groups, and only one patient in the LTAP group had a PVA Z-score > 1.0 during follow-up. The 15-year freedom from reoperation between the LTAP and SV groups was (89 % vs. 91 % p=0.6). Greater age at the time of ToF repair was protective (Hazard Ratio: 0.989, 95% CI: 0.979, 0.998; p=0.01); however, PVA Z-Score or LTAP repair was not associated with reoperation.
Conclusions: Infants following a Dacron LTAP have linear PVA growth, allowing future percutaneous pulmonary valve replacement and similar reoperation rates to those requiring only a SV repair.