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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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“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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“Several techniques including pulmonary valvotomy, trans-annular patch and incision in the right ventricular (RV) infundibulum predispose to the development of late-onset PR (1,2).”
Cochran, C. D., Yu, S., Gakenheimer-Smith, L., Lowery, R., Lu, J. C., Mahani, M. G., Agarwal, P., & Dorfman, A. (2018) · American Journal of Cardiology · doi:10.1016/s0735-1097(18)31160-4 · Cited by 6
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“Moreover, the type of repair can impress the right ventricle outflow tract and its function in the late postoperative period [19, 20].”
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Ramanan, S., Sasikumar, N., Manohar, K., Ramani, S. S., Kumar, R., Agarwal, R., Subramanyam, R., & Cherian, K. M. (2019) · Asian Cardiovascular and Thoracic Annals · doi:10.1177/0218492319882870 · Cited by 4
Polytetrafluoroethylene Monocusp Valve Reconstruction of the Right Ventricular Outflow Tract
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Total Correction of Tetralogy of Fallot: Effect of Transannular Patch on Early Outcome
Khan, A., Hasan, K., Salam, A., Azad, Q. A., Siddiqua, S. S., Islam, Z., Khan, S., & Bari, S. (2018) · doi:10.3329/cardio.v10i2.36291 · Cited by 3
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“Within 20 years of follow-up, 7 % of the patients needed reoperation by pulmonary valve implantation for RV failure, whereas this number increased to even 20 % in presence of co-existent distal pulmonary artery stenosis [6].”
BackgroundSingh, S., Pratap, H., Agarwal, S., Singh, A. K., & Satsangi, D. K. (2011) · Indian Journal of Thoracic and Cardiovascular Surgery · doi:10.1007/s12055-011-0093-5 · Cited by 7
“Elective annular enlargement using a Transannular Patch [TAP] in these patients is associated with free Pulmonary Regurgitation [PR], which in turn has been causally linked to an array of abnormalities complicating the immediate post-operative course as well as adversely affecting the long term outlook, including righ…”
MethodChiu, I., Div., M., Huang, S., Wu, S., Lee, M.-L., Wu, E., Chen, S., & Chen, M. (2009) · The Annals of Thoracic Surgery · doi:10.1016/j.athoracsur.2008.12.083 · Cited by 3
Successful heart transplantation with acquired pulmonary artery atresia.
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Long-term Outcomes of Tetralogy of Fallot in the Kingdom of Bahrain
Agarwal, A., Amer, S. R. A., Tarif, H. A., Ismael, A. A., Alshaiji, A. F., Arulselvam, V., & Kalis, N. N. (2022) · Heart Views · doi:10.4103/heartviews.heartviews_77_21
“[14,15,17,20,21,22,28] A mild right ventricular outflow tract (RVOT) gradient is shown to be advantageous in reducing the need for future pulmonary valve replacements (PVR), [29] thus inclination towards preservation of pulmonary valve and intentionally leaving a small gradient in RVOT, has led to…”
Architecture matters: Tissue preservation strategies for tetralogy of Fallot repair
Shimoda, T., Mathis, B. J., Kato, H., Matsubara, M., Suzuki, Y., Suetsugu, F., & Hiramatsu, Y. (2021) · Journal of cardiac surgery · doi:10.1111/jocs.15584 · Cited by 2
Roberts, W. C., & Siddiqui, S. (2021) · Cardiovascular Pathology · doi:10.1016/j.carpath.2021.107332 · Cited by 2
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“It is increasingly recognized that right-sided valve disease is not a benign lesion and that it has a significant and an independent impact on morbidity and mortality.1 Surgical procedure often involves pulmonary valvulotomy, a transannular patch, or incision in the right ventricular (RV) infundibulum, which can all c…”
BackgroundAn audit of surgical repair of Tetralogy of Fallot in an African tertiary care centre
Ngwezi, D. P., Vanderdonck, K. M., Levin, S. E., & Cilliers, A. M. (2017) · SA Heart · doi:10.24170/10-3-1792 · Cited by 2
“One study differed in their findings, with the majority of their patients (66%) undergoing a simple repair and the remainder (31%) having a complex repair in the form of a TAP.(10) The disparity”
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“Studies report that severe PR is reported in 30% of patients at 20-year follow-up [7] though less than 20% of patients need repeat surgical intervention of RVOT [8].”
Talwar, S., Saurabh, G., Bhushan, S., Bhende, V. V., & Gupta, V. P. (2025) · Annals of Pediatric Cardiology · doi:10.4103/apc.apc_16_25 · Cited by 1
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“The introduction of cardiopulmonary bypass enabled the surgical opening of the right ventricular (RV) out fl ow tract using the Brock procedure, valvulotomy, or a transannular patch (4).”
Pasquale, L., Jäger, O., Erdil, T., Christmann, M., Quandt, D., Cesnjevar, R. A., & Dave, H. H. (2023) · JTCVS Techniques · doi:10.1016/j.xjtc.2023.03.013 · Cited by 3
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“Some studies have suggested that compensatory responses to right ventricular volume overload are adequate for a long period.[2,3] Progressive right ventricular dilation, biventricular dysfunction, ventricular arrhythmias, and sudden cardiac death have been recognized as late sequelae of chronic PR in patients with rep…”
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“The studies conducted to determine risk factors for mortality showed that one previous operation for classic shunt is not considered a risk factor, but more than one palliative operation is (19).”
BackgroundTransatrial approach for total tetralogy of Fallot TOF correction: analysis of 24 cases.
Attar, M., & Ammar, A. (2017) · doi:10.32007/med.1936/jfacmedbagdad.v59i4.1 · Cited by 1
Tetralogy of Fallot: Managing the Right Ventricular Outflow
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“The early and late potential problems with a transannular patch were clearly defined by Kirklin [ 5 ] who reported on a series of 814 repaired TOF patients operated between 1967 and 1986 and followed for up to 20 years.”
BackgroundTransannular patch repair of tetralogy of Fallot
Nakano, T. (2026) · Asian Cardiovascular and Thoracic Annals · doi:10.1177/02184923261428822
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Pulmonary Annulus Growth Pattern in Patients with Tetralogy of Fallot Prior to Surgical Repair
Kindi, H. A. A., Kaabi, S. A., Harthi, H. A., Harthi, T. A., Habsi, A. A., & Kandachar, P. (2023) · Sultan Qaboos University Medical Journal · doi:10.18295/squmj.12.2023.077
“13 Several studies highlight the advantages of preserving the pulmonary valve in TOF repair.”
BackgroundUpadhyay, V., Nayak, P., Patel, R., & Lukhi, S. (2023) · Heart India · doi:10.4103/heartindia.heartindia_11_23
Khalid, Z. R., Mughal, A. R., & Gul, H. (2023) · Pakistan Postgraduate Medical Journal · doi:10.51642/ppmj.v34i01.574
Kết quả dài hạn sau phẫu thuật tứ chứng fallot tại Trung tâm Tim mạch - Bệnh viện Nhi Trung ương
Ly, T. T. N. (2021) · Journal of Clinical Medicine- Hue Central Hospital · doi:10.38103/jcmhch.2021.73.6
Tuấn, N. Đ., & Định, N. H. (2020) · Tạp chí Phẫu thuật và Tim mạch và Lồng ngực Việt Nam · doi:10.47972/vjcts.v20i.91
Aghaei-Moghadam, E., Nikoufar, M., Kocharian, A., Pour, K. S., Mirzaaghayan, M., Radmehr, H., Rezaei, M., Mohebbi, A., & Ghamari, A. (2019) · Journal of Comprehensive Pediatrics · doi:10.5812/compreped.84530
Early outcome of tetralogy of Fallot repair among Bangladeshi patients
Hoque, K. Z., Chowdhury, M., Mia, M., Islam, M. A., & Hossain, M. (2019) · International Journal of Research in Medical Sciences · doi:10.33545/26648733.2019.v1.i1a.3
“[20] suggested that the compensatory responses to RV overload were adequate for a 20-year period, at least with respect to mortality.”
BackgroundRevalvulation pulmonaire et risque rythmique chez les patients opérés d’une tétralogie de Fallot
Pilato, R., Lacroix, D., Domanski, O., & Godart, F. R. (2017) · La Presse Médicale · doi:10.1016/j.lpm.2017.02.006
Borowski, A., Ghodsizad, A., Litmathe, J., Godehardt, E., Lawrenz, W., Schmidt, K., & Gams, E. (2003) · Zeitschrift für Herz- Thorax- und Gefäßchirurgie · doi:10.1007/s00398-003-0399-8
“Um ausgeprägten PR adäquat begegnen zu können, ist bei mindestens 12% der Patienten, bezogen auf ein Follow-up von 20 Jahren ein PVR erforderlich (15), und die Notwendigkeit wird sich möglicherweise mit der Zeit weiter vergrößern.”
BackgroundLarge systemic collateral arteries developing late after total repair of tetralogy of Fallot.
Jt, L. (1992) · doi:10.1016/1010-7940(92)90072-6
“However, pulmonary regurgitation is normally tolerated well after total repair especially in patients without residual pulmonary stenosis [ 3 ].”
Background
Metadata
- 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 › 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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