Cited by 175Congenital Heart Disease StudiesCardiac Valve Diseases and TreatmentsCongenital heart defects research

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Effect of transannular patching on outcome after repair of tetralogy of Fallot

Kirklin, James K., Kirklin, John W., Blackstone, Eugene H., Milano, Aldo, Pacifico, Albert D.·1989·The Annals of Thoracic Surgery

DOI 10.1016/0003-4975(89)90671-1

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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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Background
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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).”
Background
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“operated tetralogy of Fallot patients and in other congenital anomalies of the right ventricular outflow tract after surgical or percutaneous interventions [9, 16].”
Background
Balloon pulmonary valvotomy as interim palliation for symptomatic young infants with tetralogy of Fallot
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Background
Factors 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
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
Flow Energy Loss as a Predictive Parameter for Right Ventricular Deterioration Caused by Pulmonary Regurgitation After Tetralogy of Fallot Repair
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
A new pulmonary valve cusp plasty technique markedly decreases transannular patch rate and improves midterm outcomes of tetralogy of Fallot repair
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
“(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].”
Background
Successful 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
“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].”
Background
Quality 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
“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).”
BackgroundInfluential
Quantitative Assessment of Pulmonary Insufficiency by Doppler Echocardiography in Patients with Adult Congenital Heart Disease
Yang, 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
Tetralogy of fallot
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
Management of pulmonary
Graham, T. P. (2002) · Current Cardiology Reports · doi:10.1007/s11886-002-0128-z · Cited by 26
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
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”
Background
Outcomes in Young Adults With Tetralogy of Fallot and Pulmonary Annular Preserving or Transannular Patch Repairs
Ducas, 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
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
“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].”
Result
Transcatheter 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
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
Hemodynamic and Electrocardiographic Effects of Early Pulmonary Valve Replacement in Pediatric Patients After Transannular Complete Repair of Tetralogy of Fallot
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
“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 ].”
Background
Surgically 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
Pedicled pericardium for repair of right ventricular outflow tract and pulmonary arterial stenoses in tetralogy of Fallot: a six-year experience.
Khoury, W., Lang-Lazdunski, L., Vernant, F., Thibert, M., & Leca, F. (1996) · Journal of Thoracic and Cardiovascular Surgery · doi:10.1016/s0022-5223(96)70270-2 · Cited by 18
Tetralogy of Fallot With Atrioventricular Septal Defect: Surgical Strategies for Repair and Midterm Outcome of Pulmonary Valve-Sparing Approach
Gupta, U., Polimenakos, A. C., El-Zein, C. F., & Ilbawi, M. N. (2012) · Pediatric Cardiology · doi:10.1007/s00246-012-0558-3 · Cited by 13
“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].”
Background
Mortality and risk factors for late deaths in tetralogy of Fallot: the Japanese Nationwide Multicentric Survey
Niwa, 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
Tetralogy of Fallot Across the Lifespan: A Focus on the Right Ventricle
Ganni, E., Ho, S. Y., Reddy, S., Therrien, J., Kearney, K. L., Roche, S. L., Dimopoulos, K., Mertens, L., Bitterman, Y., Friedberg, M. K., et al. (2023) · CJC Pediatric and Congenital Heart Disease · doi:10.1016/j.cjcpc.2023.10.009 · Cited by 20
“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.”
Background
Infective Endocarditis Risk with Melody versus Sapien Valves Following Transcatheter Pulmonary Valve Implantation: A Systematic Review and Meta-Analysis of Prospective Cohort Studies
Balakrishna, 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
“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].”
Background
Pulmonary 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
PLAIN FILM DIAGNOSIS OF COMMON CARDIAC ANOMALIES IN THE ADULT
Baron, M. G. (1999) · Radiologic Clinics of North America · doi:10.1016/s0033-8389(05)70101-9 · Cited by 15
Transannular outflow tract patching for tetralogy: indications and results.
Kirklin, J., Kirklin, J., & Pacifico, A. (1990) · Seminars in Thoracic and Cardiovascular Surgery · doi:10.5555/uri:pii:104306799090038o · Cited by 15
Self-citation
Tetralogy of Fallot in teenagers and adults: surgical experience and follow-up
Bisoi, A. K., Murala, J. S. K., Airan, B., Chowdhury, U. K., Kothari, S. S., Pal, H., Patel, C. D., Cheemalapati, S. K., Chauhan, S., & Panangipalli, V. (2007) · General Thoracic and Cardiovascular Surgery · doi:10.1007/s11748-006-0087-1 · Cited by 14
Accuracy of a New Echocardiographic Index to Predict Need for Trans-annular Patch in Tetralogy of Fallot
Kasturi, S., Balaji, S., Sudhakar, A., Sunil, G. S., Kottayil, B., Bayya, P., & Kumar, R. (2018) · Pediatric Cardiology · doi:10.1007/s00246-018-1973-x · Cited by 14
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
Onan, I., Ergün, S., Özturk, E., Çelik, E., Ayyıldız, P., & Onan, B. (2020) · Journal of cardiac surgery · doi:10.1111/jocs.14860 · Cited by 13
Fate of right ventricle to pulmonary artery conduits after complete repair of pulmonary atresia and major aortopulmonary collaterals.
Mainwaring, R., Patrick, W., Punn, R., Palmon, M., Reddy, V., & Hanley, F. (2015) · Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2014.12.071 · Cited by 13
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
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
Ventricular remodelling after pulmonary valve replacement: comparison between pressure-loaded and volume-loaded right ventricles.
Gorter, T., van Melle, J. V., Hillege, H., Pieper, P., Ebels, T., Hoendermis, E., Bartelds, B., Willems, T., & Berger, R. (2014) · Interactive Cardiovascular and Thoracic Surgery · doi:10.1093/icvts/ivu097 · Cited by 12
“osis (PS) and/or pulmonary regurgitation (PR) [1, 2].”
Palliative balloon valvoplasty of the pulmonary valve in tetralogy of Fallot
Massoud, I., Imam, A. A. H., Mabrouk, A., Boutros, N., Kassem, A., Daouod, A., Abd, M., & Hakem, E. (1999) · Cardiology in the Young · doi:10.1017/s1047951100007344 · Cited by 12
The clinical impact of percutaneous balloon expandable endovascular stents in the management of early postoperative vascular obstruction
Hatai, Y., Nykanen, D., Williams, W., Freedom, R., & Benson, L. (1996) · Cardiology in the Young · doi:10.1017/s1047951100003243 · Cited by 11
Right Ventricular Remodeling in Complex Congenital Heart Disease
Demonceaux, M., Benseba, J., Ruiz, M., Mongeon, F., Khairy, P., Mital, S. R., Dore, A., Mondesert, B. A., Tremblay‐Gravel, M., Dib, N., et al. (2025) · Canadian Journal of Cardiology · doi:10.1016/j.cjca.2025.01.005 · Cited by 8
Effect of Pulmonary Valve Replacement in the Repaired Tetralogy of Fallot Patients with Trans-annular Incision: More than 20 Years of Follow-up
Kwak, J. G., Shin, H. J., Bang, J. H., Kim, E. R., Lee, J. R., Kim, W., Bae, E. J., Song, M. K., & Kim, G. B. (2021) · Korean Circulation Journal · doi:10.4070/kcj.2020.0331 · Cited by 10
Primary repair of tetralogy of Fallot in infants: Transatrial/transpulmonary or transventricular approach
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CMR assessment of right ventricular function in patients with combined pulmonary stenosis and insufficiency after correction of tetralogy of Fallot
Kohi, M. P., Ordovas, K. G., Naeger, D. M., Meadows, A. K., Foster, E., & Higgins, C. B. (2013) · Acta Radiologica · doi:10.1177/0284185113491565 · Cited by 8
“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)
ORCID: Kirklin, James K.
Blackstone, Eugene H.
Milano, Aldo
Venue: The Annals of Thoracic Surgery
Publisher: Elsevier BV
Published: 1989-12
Volume: 48
Issue: 6
Pages: 783-791
ISSN: 0003-4975 (ISSN-L)
DOI: 10.1016/0003-4975(89)90671-1
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
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/legal/tdmrep-license (tdm)
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 › Cardiology and Cardiovascular Medicine › 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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Effect of transannular patching on outcome after repair of tetralogy of Fallot

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