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The Legenda in Tetralogy of Fallot Repair: Better Short and Mid-term Outcomes

Ahmed Al-Gebaly, Rania Aboushokka, Hanan Mohammed and Yahia Mahmoud

Aim of the study: To detect the early and mid-term outcome of pulmonary valve sparing technique used with the trans-annular patch implantation in tetralogy of Fallot repair.

Introduction: Since more than half a century, after the successful repair of tetralogy of Fallot, the pulmonary insufficiency became the determinant of long-term outcome regarding: RV function, need for pulmonary valve replacement and post-operative arrythmia. Pulmonary valve sparing (PVS) at the expense of avoidance of trans-annular valve was associated with residual pressure gradient across RVOT.

Patients and methods: A retrospective study done Between Jan 2013 and Jan 2017; on a group of patients diagnosed as Tetralogy of Fallot with Hypoplastic pulmonary annulus (defined as pulmonary valve annulus Z value ≤-3). Those patients were submitted to surgical repair with trans-annular patch to relief the Right Ventricle. There were 33 patients had received a modified pulmonary valve sparing technique and the rest were operated by classic trans-annular patch. The Pressure gradient (PG) across the Right ventricle outflow tract (RVOT) were calculated directly and with Epicardial Echocardiography in the operating room then follow up echo on postoperative outpatients’ visits. The Pulmonary Regurgitation was graded by the echocardiographer as (0-3).

Results: In (PVS) group was 23 male and 10 females; and for the control group there were 32 male and 16 females (p-Value: 0.7). The Mean age for Case group were (10.17 ± 2.59) Months and for the control group (10.21 ± 2.89) Months, (p-value: 0.94).

All patients in (PVS) group had pulmonary commissurotomy and anterior release to the pulmonary annulus, follow up Echocardiography for the RVOT gradient revealed; the mean gradient for the case group was 16.00 ± 3.39 and for the control group 14.35 ± 4.51; (p-Value: 0.07).

Evaluation of Pulmonary regurgitation revealed; in the case group 3 had no to trivial, 16 had mild, 14 had mod and no patient had severe pulmonary regurgitation. In contrary to the control group who had 1 patient had mild, 35 patients had mod and 12 patients had severe, (p-Value: <0.0001).

Conclusion: Pulmonary valve sparing techniques include multiple strategies all of them aim to spare the integrity of the pulmonary valve. Adding annular release and transannular patch overcome the fixed part of the Right ventricular outflow. The net result is potentially competent valve with the least gradient.