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- Title
Pulmonary atresia with ventricular septal defect and tetralogy of Fallot: transannular path augmentation versus systemic to pulmonary artery shunt for first-stage palliation.
- Authors
Lenoir, Marien; Fouilloux, Virginie; Desnous, Beatrice; Rahmani, Bilal; El Gueddari, Nabila; Ovaert, Caroline; Aries, Edouard; El Louali, Fedoua; Aldebert, Philippe; Metras, Dominique; Macé, Loic
- Abstract
<bold>Background: </bold>Pulmonary atresia with ventricular septal defect and severe tetralogy of Fallot require a palliative procedure for pulmonary artery rehabilitation. For first-stage palliation, two main surgical options are still debated: right ventricle to pulmonary artery connection and modified Blalock-Taussig shunt. We compared the clinical outcomes of the two procedures.<bold>Methods: </bold>From 1995 to 2018, 88 patients needed palliation (pulmonary atresia with ventricular septal defect n = 47; tetralogy of Fallot n = 41). Among these patients, 70 modified Blalock-Taussig shunt and 18 transannular path augmentation were performed before 6 months of age. Using a 1:1 propensity score match analysis, 20 patients were included in the analysis. The primary outcome was in-hospital mortality and pulmonary artery growth.<bold>Results: </bold>After matching, the pre-operative Nakata was smaller in transannular path augmentation 54 ± 24 mm2/m2 than modified Blalock-Taussig shunt 109 ± 31 mm2/m2 (p < 0.001). The age and weight were similar (p = 0.31 and p = 0.9, respectively). There was no difference in in-hospital mortality (p = 0.3). The Nakata index before biventricular repair and delta Nakata were smaller in modified Blalock-Taussig shunt group (206 ± 80 mm2/m2, 75 ± 103 mm2/m2) than transannular path augmentation (365 ± 170 mm2/m2, 214 ± 165 mm2/m2; p = 0.03; p < 0.001). Median time to biventricular repair was similar (p = 0.46). The rate of interstage reintervention was similar (p = 0.63).<bold>Conclusions: </bold>The transannular path augmentation is better for the rehabilitation of the native pulmonary artery. Despite a smaller pulmonary artery, right ventricle to pulmonary artery connection is equivalent to modified Blalock-Taussig shunt for rate of biventricular repair and time to biventricular repair.
- Subjects
VENTRICULAR septal defects; PULMONARY atresia; PULMONARY artery; TETRALOGY of Fallot; PROPENSITY score matching
- Publication
Cardiology in the Young, 2020, Vol 30, Issue 11, p1679
- ISSN
1047-9511
- Publication type
journal article
- DOI
10.1017/S1047951120002553