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- Title
The impact of native Fallot anatomy on future therapeutic requirements and outcomes at follow-up.
- Authors
Ravaglioli, Antonio; Ait-Ali, Lamia; Federici, Duccio; Salvadori, Stefano; Pllumi, Arketa; Pak, Vitali; Marrone, Chiara; Pizzuto, Alessandra; Bonhoeffer, Philipp; Festa, Pierluigi
- Abstract
<bold>Background: </bold>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 (PV) annulus and branches on future therapeutic requirements and outcomes.<bold>Method: </bold>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.<bold>Results: </bold>Among the 312 patients, a description of the PV and pulmonary arteries (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 PV and PAs; group 2 (108 patients) with PV hypoplasia but normal size PAs; group 3 (66 patients) with concomitant hypoplasia of the PV and PAs. 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 PV and PAs was an independent predictor of subsequent procedures (HR:3.1,CI:1.06-9.1, p = 0.03).<bold>Conclusion: </bold>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.
- Subjects
PULMONARY valve; OPERATIVE surgery; TETRALOGY of Fallot; ANATOMY; MEDICAL records; PULMONARY artery
- Publication
Cardiovascular Ultrasound, 2021, Vol 19, Issue 1, p1
- ISSN
1476-7120
- Publication type
journal article
- DOI
10.1186/s12947-021-00249-y