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Early outcome of fallot repair with preservation of the pulmonary valve annulus versus transannular patch


Mohamed Ezzeldin Azzam , Ahmed Sultan Mohamed , Hesham Abdelfattah Shawky , Tarek Ahmed Nossier , Alaa Mohamed Omar , Michael Atef Morcos , Mahmoud Gamaleldin Ali

Abstract

Background: Pulmonary valve incompetence following transannular patch repair of tetralogy of Fallot, results in long term morbidity and mortality. Pulmonary valve preservation (PVP) has recently gained recognition even in repair of patients with Z score -3 or less. The aim of the study was to evaluate the results with pulmonary valve preservation versus transannular patch in selected patients with tetralogy of Fallot, according to pulmonary valve annulus Z score. Methods: This was a prospective, comparative study that enrolled a total of 50 patients, 25 within each group. Results: There was no significant difference in age, sex, BSA and oxygen saturation between 2 groups, median Z score in PV preservation was -3.22 while in TAP, it was -3.89 (P value=0.001), mean cross clamp time in PV preservation 48.76±11.65 (P value =0.0001), mean mechanical ventilation in PVP 10.2± 4.50 Hr (P value = 0.005), mean ICU stay in PVP was 4.76 ± 2.0 days (P value=0.03), median RVOT PG in PVP was 30(15-50) mmhg while in TAP, it was 27 (15-76) mmhg (P value > 0.05), the degree in PV regurgitation in group A was none/mild in 20 patients (80%) and moderate in 5 patients ( 20%), in group B, it was non/mild in 6 patients (24%), moderate in 8 patients (32%) and severe in 11 patients (44%) (P value= 0.01). There was one case of mortality in group A, and 3 in group B (P value> 0.05).b Conclusion: PV annulus preservation technique should be adopted in almost all patients with TOF due to its superior outcome in maintaining a competent pulmonary valve.



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