Effect of transannular patching on outcome after repair of tetralogy of Fallot
Abstract
Among 814 patients undergoing repair of tetralogy of Fallot with pulmonary stenosis between 1967 and May 1986, transannular patching in the current era was a weak risk factor for death early postoperatively (predicted 30-day mortality, 4% with a transannular patch and 1.4% without) and is not a risk factor for instantaneous risk of death late postoperatively (predicted 20-year survival including early death, 94% with a transannular patch and 96.5% without). Ninety-six percent of surviving patients were in New York Heart Association functional class I at last follow-up, and the slight decline in this percentage as the interval between operation and last follow-up lengthened could have been due to chance alone (p = 0.24) and was no different in patients with a transannular patch. Transannular patching was a risk factor for reoperation for pulmonary regurgitation late postoperatively, but only a 7% incidence within 20 years is predicted when mild residual stenoses are beyond the patch: the incidence rises to about 20% with important distal stenoses. Inferences from the study are relevant to the indications for transannular patching and insertion of allograft semilunar valves at the time of repair.
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Studies based on multicenter surgical registries found increased survival and decreased reintervention rates among patients who underwent a VS procedure compared with those who underwent TAP.
“The risk-benefit balance of VS procedures compared with TAP remains unclear in this setting even if studies3,16,17,18,19,20 based on multicenter surgical registries found increased survival and decreased reintervention rates among patients who underwent a VS procedure compared with those who underwent TAP.”
From Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot (2021) · cites this paper as [19]
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Long-term outcome in patients undergoing surgical repair of tetralogy of Fallot
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“Pulmonary insufficiency and right ventricular dysfunction, which are universally present to some degree after tetralogy repair, may be poorly tolerated if there are additional residual lesions [6-9].”
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PTFE monocusp valve reconstruction of the right ventricular outflow tract.
Turrentine, M., McCarthy, R. P., Vijay, P., McConnell, K., & Brown, J. W. (2002) · Annals of Thoracic Surgery · doi:10.1016/s0003-4975(01)03441-5 · Cited by 105
“Echocardiographic assessment of the MO valve was reported only for patients beyond 6 months postimplant and PI was assigned numerical values (mild [1], moderate [2], severe [3]) for analysis.”
BackgroundMethodInfluentialEarly Balloon Dilatation of the Pulmonary Valve in Infants With Tetralogy of Fallot
Sluysmans, T., Neven, B., Rubay, J., Lintermans, J. P., Ovaert, C., Mucumbitsi, J., Shango, P., Stijns, M., & Vliers, A. (1995) · Circulation · doi:10.1161/01.cir.91.5.1506 · Cited by 99 · see citing works
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“The current surgical policy in TOF, aimed at early complete surgical correction, results in considerable transannular patch rates, which induces residual pulmonary regurgitation [39].”
BackgroundResultThe long-term result of total repair for tetralogy of Fallot
Park, C. S., Lee, J. R., Lim, H.-G., Kim, W.-H., & Kim, Y. J. (2010) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2010.02.030 · Cited by 99 · see citing works
“that showed poorer survival and an increased frequency of pulmonary regurgitation late after total repair using a transannular patch [18,19].”
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Alexiou, C., Mahmoud, H., Al-Khaddour, A., Gnanapragasam, J., Salmon, A. P., Keeton, B. R., & Monro, J. L. (2001) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(00)02444-9 · Cited by 98 · see citing works
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Timing and type of surgery for severe pulmonary regurgitation after repair of tetralogy of Fallot
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“Although Kirklin had shown that a transannular patch was a predictor of early post-operative death, several of the early tetralogy of Fallot series suggested that pulmonary regurgitation, or rather a transannular patch as a surrogate measure, had little impact on late survival (54).”
BackgroundEarly replacement of pulmonary valve after repair of tetralogy: is it really beneficial?☆
Lim, C., Lee, J. Y., Kim, W., Kim, S.-C., Song, J., Kim, S., Choh, J.-H., & Kim, C. W. (2004) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2004.01.036 · Cited by 82 · see citing works
“Associated problems such as residual ventricular septal defect, tricuspid valve regurgitation (TR), and distal pulmonary artery stenosis can aggravate those adverse effects of PR [5].”
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“Some studies [10,11] report good long-term outcomes after TOF repair with transannular patch, with low incidence of redo procedures, despite a significant, high degree of pulmonary regurgitation, and this is ascribed to the adaptive properties of the right ventricle.”
BackgroundLong-term outcome after surgery for pulmonary stenosis (a longitudinal study of 22–33 years)
Roos‐Hesselink, J. W., Meijboom, F. J., Spitaels, S. E. C., VANDOMBURG, R., vanRijen, E. H. M., Utens, E. M. W. J., Bogers, A. J. J. C., & Simoons, M. L. (2005) · European Heart Journal · doi:10.1093/eurheartj/ehi685 · Cited by 79 · see citing works
“The transannular patch technique is a well-recognized risk factor for the development of pulmonary regurgitation in Fallot patients and now proofs to be a risk factor in isolated pulmonary valve stenosis patients as well.(11) This implies that patients after surgical repair of pulmonary stenosis with a transannular pa…”
BackgroundTotal correction of tetralogy of Fallot in the first year of life: late results.
Cobanoglu, A., & Schultz, J. M. (2002) · The Annals of Thoracic Surgery · doi:10.1016/s0003-4975(02)03619-6 · Cited by 70 · see citing works
“Another concern relates to the higher incidence of transannular patching, which has been associated with a risk of early death, and could lead to more severe pulmonary regurgitation and right ventricular dysfunction [8, 12, 16].”
BackgroundResultArrhythmias late after repair of tetralogy of fallot: a Japanese Multicenter Study.
Nakazawa, M., Shinohara, T., Sasaki, A., Echigo, S., Kado, H., Niwa, K., Oyama, K., Yokota, M., Iwamoto, M., Fukushima, N., et al. (2004) · Circulation Journal · doi:10.1253/circj.68.126 · Cited by 69 · see citing works
Survival analysis of infants under age 18 months presenting with tetralogy of Fallot.
Vobecky, S. J., Williams, W. G., Trusler, G., Coles, J., Rebeyka, I., Smallhorn, J., Burrows, P. E., Gow, R. M., & Freedom, R. (1993) · Annals of Thoracic Surgery · doi:10.1016/0003-4975(93)90361-k · Cited by 65 · see citing works
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Blais, S., Marelli, A., Vanasse, A., Dahdah, N., Dancea, A., Drolet, C., & Dallaire, F. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2021.18141 · Cited by 61 · see citing works
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“[12] in 1989, due to postoperative pulmonary regurgitation (PVR) particularly if significant distal pulmonary vessel stenoses had developed.”
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“It has been reported that prolonged exposure to PR caused by transannular patch can lead to progressive RV distention, increasing tricuspid regurgitation, dysfunction of both right and left ventricles, ventricular arrhythmias, and sudden death [17–20].”
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“In several clinical studies PR, as isolated congenital lesion [5] or developing after surgical repair of RVOTO [1–3], has been reported to be well tolerated.”
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Bové, T., François, K., Kerckhove, K. V. D., Panzer, J., Groote, K. D., Wolf, D. D., & Nooten, G. V. (2011) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2011.03.050 · Cited by 64 · see citing works
“More than 50 years’ experience with surgical treatment of tetralogy of Fallot (ToF) has revealed that the physiological sequelae of the formerly performed transventricular repair with a large trans-annular patch are not benign in the long-term [1–3].”
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Kondo, C., Nakazawa, M., Kusakabe, K., & Momma, K. (1995) · Circulation · doi:10.1161/01.cir.92.9.250 · Cited by 61 · see citing works
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“To control the pulmonary regurgitation, PVR is necessary in at least 12% of patients at 20-years-follow-up [14], and the incidence will probably increase with time.”
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“It has been well known that severe PR can adversely affect early and late outcomes of TOF repair [5, 6].”
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Tetralogy of Fallot: influence of right ventricular outflow tract reconstruction on late outcome
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Late Complications Following Tetralogy of Fallot Repair: The Need for Long-term Follow-Up
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“This is a timerelated phenomenon, with 10-, 20- and 30-year freedom from reoperation being 95% to 97%, 92% and 88%, respectively (19,21,22).”
BackgroundÁlvarez-Fuente, M., Garrido-Lestache, E., Fernández-Pineda, L., Romera, B., Sánchez, I., Centella, T., Abelleira, C., Villagrá, S., Tamariz, R., Barrios, E., et al. (2016) · Pediatric Cardiology · doi:10.1007/s00246-015-1320-4 · Cited by 32
“operated tetralogy of Fallot patients and in other congenital anomalies of the right ventricular outflow tract after surgical or percutaneous interventions [9, 16].”
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Surgery for Tetralogy of Fallot in Adults: Early Outcomes
Khan, I., Tufail, Z., Afridi, S., Iqbal, M., Khan, T., & Waheed, A. (2016) · Brazilian Journal of Cardiovascular Surgery · doi:10.5935/1678-9741.20160063 · Cited by 29 · see citing works
“A large study by Kirklin et al.[15] suggested that the compensatory responses to RV overload were adequate for a 20-year period, at least with respect to mortality.”
BackgroundFactors affecting perioperative mortality in tetralogy of Fallot
Saygı, M., Ergul, Y., Tola, H., Ozyilmaz, I., Ozturk, E., Onan, I., Haydın, S., Erek, E., Yeniterzi, M., Guzeltas, A., et al. (2015) · Pediatrics International · doi:10.1111/ped.12627 · Cited by 28 · see citing works
Classical repair of tetralogy of Fallot: timing, technique, and results.
Castañeda, A. R. (1990) · Seminars in Thoracic and Cardiovascular Surgery · doi:10.5555/uri:pii:104306799090039p · Cited by 28
Shibata, M., Itatani, K., Hayashi, T., Honda, T., KITAGAWA, A., Miyaji, K., & Ōno, M. (2018) · Pediatric Cardiology · doi:10.1007/s00246-018-1813-z · Cited by 30 · see citing works
Hua, Z., Li, S., Wang, L., Hu, S., & De, W. (2011) · European Journal of Cardio-Thoracic Surgery · doi:10.1016/j.ejcts.2011.02.035 · Cited by 25 · see citing works
“(3) When the main pulmonary artery was small and the diameter of pulmonary annulus was tiny and could not pass a 3 standard deviation below the normal predicted annulus diameter for the patient’s weight, then TAP was applied [3].”
BackgroundSuccessful implantation of a decellularized equine pericardial patch into the systemic circulation
Dohmen, P., da Costa, F. D., Lopes, S. V., Vilani, R., Bloch, O., & Konertz, W. (2014) · Medical science monitor basic research · doi:10.12659/msmbr.889915 · Cited by 26 · see citing works
“A limitation of these implants is that they are permanent foreign bodies with the potential for infection and the absence of remodeling, regeneration, and growth potential [5,6].”
BackgroundQuality of life after repair of tetralogy of Fallot
Walker, W., Temple, I., Gnanapragasam, J. P., Goddard, J., & Brown, E. M. (2002) · Cardiology in the Young · doi:10.1017/s1047951102000999 · Cited by 26
Early outcome of tetralogy of Fallot repair in the current era of management
Ismail, S. R., Kabbani, M. S., Najm, H. K., Abusuliman, R. M., & Elbarbary, M. A. (2010) · Journal of the Saudi Heart Association · doi:10.1016/j.jsha.2010.02.006 · Cited by 31 · see citing works
“Different to what was thought formerly to be well tolerated following TAP repair, significant pulmonary regurgitation turned out to be unsafe and harmful as it may progress to significant morbidity and even mortality (Kirklin et al., 1989; Sunakawa et al., 1988; Cullen et al., 1995).”
BackgroundInfluentialYang, H., Pu, M., Chambers, C. E., Weber, H. S., Myers, J. L., & Davidson, W. R. (2007) · Journal of the American Society of Echocardiography · doi:10.1016/j.echo.2007.06.003 · Cited by 28 · see citing works
Gouw, S. C., Le, T.-N., & Sreeram, N. (2001) · Current Treatment Options in Cardiovascular Medicine · doi:10.1007/s11936-001-0026-5 · Cited by 24 · see citing works
Graham, T. P. (2002) · Current Cardiology Reports · doi:10.1007/s11886-002-0128-z · Cited by 26 · see citing works
Outcome and Incidence of Re‐Intervention After Surgical Repair of Tetralogy of Fallot
Bakhtiary, F., Dähnert, I., Leontyev, S., Schröter, T., Hambsch, J., Mohr, F., & Kostelka, M. (2013) · Journal of cardiac surgery · doi:10.1111/jocs.12030 · Cited by 22 · see citing works
Pericardial Monocusp for Pulmonary Valve Reconstruction: A New Technique
Pande, S., Agarwal, S., Majumdar, G., Chandra, B., Tewari, P., & Kumar, S. (2010) · Asian Cardiovascular and Thoracic Annals · doi:10.1177/0218492310369185 · Cited by 21
“In such a setting, PI worsens with a transannular patch alone, and can lead to further RV dilatation and dysfunction with a poor prognosis.(10,11) There have been previous attempts at making a transannular patch”
BackgroundDucas, R., Harris, L., Labos, C., Nair, G. K. K., Wald, R. M., Hickey, E. J., & Silversides, C. K. (2020) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2020.04.014 · Cited by 15 · see citing works
A Novel Predictive Value for the Transannular Patch Enlargement in Repair of Tetralogy of Fallot.
Choi, K., Sung, S.-C., Kim, H., Lee, H. D., Ban, G., Kim, G., & Kim, H. (2016) · Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2015.10.050 · Cited by 20 · see citing works
“Although some studies [11, 12] demonstrated good long-term results after TOF repair with TAPE and low reoperation incidence despite a significantly high degree of pulmonary regurgitation, many have found that TAPE adversely affects early and late results after TOF repair [13–15].”
ResultTranscatheter pulmonic valve implantation: Techniques, current roles, and future implications
Law, M., & Chatterjee, A. (2021) · World Journal of Cardiology · doi:10.4330/wjc.v13.i5.117 · Cited by 19 · see citing works
Pulmonary valve replacement after repair of tetralogy of Fallot: Evolving strategies
Mosca, R. S. (2015) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/j.jtcvs.2015.09.008 · Cited by 20 · see citing works
Kleinveld, G., Joyner, R. W., Sallee, D., Kanter, K. R., & Parks, W. J. (2006) · Pediatric Cardiology · doi:10.1007/s00246-005-1137-7 · Cited by 19 · see citing works
“Key words: Tetralogy of Fallot — Electrocardiography — Magnetic resonance imaging — Pulmonary valve replacement Complete repair of Tetralogy of Fallot (TOP) often results in pulmonary regurgitation, particularly if a transannular patch is utilized during right ventricular (RV) outflow tract reconstruction [ 26 ].”
BackgroundSurgically treated pulmonary stenosis: over 50 years of follow-up
Nielsen, E. A., & Hjortdal, V. (2015) · Cardiology in the Young · doi:10.1017/s1047951115001158 · Cited by 18
Total Transatrial Correction of Tetralogy of Fallot: No Outflow Patch Technique
Airan, B., Choudhary, S. K., Kumar, H. V. J., Talwar, S., Dhareshwar, J., Juneja, R., Kothari, S. S., Saxena, A., & Venugopal, P. (2006) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2006.03.115 · Cited by 25 · see citing works
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“primary repair of TOF in early infancy has shown excellent early results but with a high use of the transannular patch (TAP) [3, 10, 21, 26].”
BackgroundNiwa, K., Hamada, H., Nakazawa, M., Terai, M., Tateno, S., Sugimoto, S., Watanabe, H., Murakami, A., Ohta, M., Ishizawa, A., et al. (2002) · Cardiology in the Young · doi:10.1017/s104795110200077x · Cited by 17 · see citing works
Tetralogy of Fallot Across the Lifespan: A Focus on the Right Ventricle
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“32 More recently, we have seen the development of a surgical approach characterized by a pulmonary valve sparing technique, 33 and it is hoped that this will improve the late trajectory of children undergoing repair today.”
BackgroundBalakrishna, A. M., Dilsaver, D. B., Aboeata, A., Gowda, R. M., Goldsweig, A. M., Vallabhajosyula, S., Anderson, J. H., Simard, T., & Jhand, A. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12154886 · Cited by 14 · see citing works
“Multiple studies have demonstrated the post-interventional residual RVOT gradient to be a major determinant of long-term outcomes, including the risk of IE [9,60].”
BackgroundPulmonary cusp augmentation in repair of tetralogy of Fallot
Attanawanich, S., Ngodgnamthaweesuk, M., Kitjanon, N., & Sitthisombat, C. (2013) · Asian Cardiovascular and Thoracic Annals · doi:10.1177/0218492312444284 · Cited by 15 · see citing works
PLAIN FILM DIAGNOSIS OF COMMON CARDIAC ANOMALIES IN THE ADULT
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Transannular outflow tract patching for tetralogy: indications and results.
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Self-citationTetralogy of Fallot in teenagers and adults: surgical experience and follow-up
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Pericardial and synthetic monocusp valves: Indication and results.
Gundry, S. (1999) · Seminars in Thoracic and Cardiovascular Surgery Pediatric Cardiac Surgery Annual · doi:10.1016/s1092-9126(99)70007-4 · Cited by 14
Early results of neopulmonary valve creation technique using right atrial appendage tissue
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Symptomatic Young Infants with Tetralogy of Fallot: One-stage versus Staged Repair
Park, C. S., Kim, W., Kim, G. B., Bae, E. J., Kim, J., Lee, J. R., & Kim, Y. J. (2010) · Journal of Cardiac Surgery · doi:10.1111/j.1540-8191.2010.01053.x · Cited by 13 · see citing works
Long-term results of pulmonary valve annular enlargement with valve repair in tetralogy of Fallot
Kim, H., Sung, S. C., Choi, K. H., Lee, H. W., Kim, G., Ko, H., & Lee, Y. S. (2017) · European Journal of Cardio-Thoracic Surgery · doi:10.1093/ejcts/ezx497 · Cited by 15 · see citing works
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“osis (PS) and/or pulmonary regurgitation (PR) [1, 2].”
Palliative balloon valvoplasty of the pulmonary valve in tetralogy of Fallot
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Right Ventricular Remodeling in Complex Congenital Heart Disease
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“Pulmonary regurgitant fraction, mean sd (%) 34 (14) 41 (17) 0.”
- Authors
- Kirklin, J. K., Kirklin, J. W., Blackstone, E. H., Milano, A., & Pacifico, A. D.
- Affiliations
- University of Alabama (US)
- University of Alabama at Birmingham (US)
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 1989-12
- Volume
- 48
- Issue
- 6
- Pages
- 783-791
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2108212766
- Cited by
- 175
- References
- 0
- Citations by year
- 2026: 1 · 2025: 5 · 2024: 5 · 2023: 7 · 2022: 4 · 2021: 7 · 2020: 5 · 2019: 6 · 2018: 5 · 2017: 4 · 2016: 2 · 2015: 8 · 2014: 6 · 2013: 8 · 2012: 3
- FWCI
- 2.09
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- CINECA IRIS Institutional Research Information System (University of Bari Aldo Moro) (submittedVersion)
- Topics
- Health Sciences › Medicine › Epidemiology › Congenital Heart Disease Studies
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Life Sciences › Biochemistry, Genetics and Molecular Biology › Molecular Biology › Congenital heart defects research
- Keywords
- tetralogy of Fallot, transannular patch, pulmonary stenosis, surgical repair, postoperative mortality, long-term survival, pulmonary regurgitation, reoperation, NYHA functional class, residual stenosis
- MeSH terms
- Child, Follow-Up Studies, Humans, Postoperative Period, Pulmonary Valve, Pulmonary Valve Stenosis, Reoperation, Risk Factors, Tetralogy of Fallot, Time Factors, Survival Rate, Survival Analysis
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