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Right Ventricular Outflow Tract Sparing Versus Transannular Patch With Right Ventricular Outflow Tract Incision In Tetralogy Of Fallot Repair
Jinyang Liu, Xianchao Jiang, Qiang Wang
Fuwai Hospital, National Center for Cardiovascular Diseases, Beijing, China

BACKGROUND: Tetralogy of Fallot is the most common cause of cyanotic congenital heart disease worldwide. An operation strategy focused on minimizing the right ventricular (RV) incision or sparing the infundibulum and has been applied over 6 years to 45 children at Fuwai Hospital.
METHODS: This is a retrospective cohort study. Consecutive patients who underwent CR-TOF at a single institution in China were included and compared according to RVOT-sparing versus TAP with incision. The primary outcome was defined as a composite of death, or reintervention, or significant annular peak gradient (APG), or significant pulmonary regurgitation (PR). We compared outcomes in patients who received RVOT-sparing with those in patients who received TAP with RVOT incision, using a multivariable Cox model with inverse probability weighting according to the propensity score.
RESULTS: From January 2012 to December 2017, of 1733 patients undergoing CR-TOF, 945 patients repaired by annulus-sparing (AS) with RVOT incision and 14 patients repaired by TAP with RVOT incision suffering from in-hospital death were excluded from the analysis. Of the remaining 774 patients, during a median follow-up duration of 50 months, 345 patients (44.6%) had a primary end-point event. In the main analysis, there was significantly inverse association between RVOT-sparing use and the primary outcome (hazard ratio [HR], 0.19, 95% confidence interval [CI], 0.06 to 0.60). In addition, patients with RVOT-sparing were associated with a greatly lower risk for significant PR (HR, 0.15, 95% CI, 0.04-0.61). Results were similar in multiple sensitivity analyses. Notably, compared with patients repaired by TAP with RVOT incision, those with RVOT-sparing experienced shorter crossclamp time (50 minutes vs 75 minutes, P<0.001), ventilation duration (11 hours vs 22 hours, P<0.001) and length of ICU stay (1 day vs 3 days, P<0.001).
CONCLUSIONS: The RVOT-sparing strategy was associated with a significantly lower risk for the composite primary outcome, as compared with TAP with RVOT incision. Midterm results suggest that CR-TOF with RVOT-sparing does appear to preserve PV function. Therefore, the RVOT-sparing strategy should be regarded as a priority chioce.

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