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Fernandez-Cisneros A, Staffa SJ, Emani SM, Chávez M, Friedman KG, Hoganson DM, Kaza AK, Del Nido PJ, Baird CW. Association of tetralogy of Fallot and complete atrioventricular canal: a single-centre 40-year experience. Eur J Cardiothorac Surg 2024; 65:ezae037. [PMID: 38310341 DOI: 10.1093/ejcts/ezae037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 12/21/2023] [Accepted: 01/31/2024] [Indexed: 02/05/2024] Open
Abstract
OBJECTIVES Outcome data in tetralogy of Fallot (ToF) and complete atrioventricular canal (CAVC) are limited. We report our experience for over 40 years in this patient population. METHODS Single-centre, retrospective analysis of patients who underwent surgical repair with the diagnosis of ToF-CAVC from 1979 to 2022, divided into 2 different periods and compared. RESULTS A total of 116 patients were included: 1979-2007 (n = 61) and 2008-2021 (n = 55). Balanced CAVC (80%) and Rastelli type C CAVC (81%) were most common. Patients in the later era were younger (4 vs 14 months, P < 0.001), fewer had trisomy 21 (60% vs 80%, P = 0.019) and fewer had prior palliative prior procedures (31% vs 43%, P < 0.001). In the earlier era, single-patch technique was more common (62% vs 16%, P < 0.001), and in recent era, double-patch technique was more common (84% vs 33%, P < 0.001). In the earlier era, right ventricular outflow tract was most commonly reconstructed with transannular patch (51%), while in more recent era, valve-sparing repairs were more common (69%) (P < 0.001). In-hospital mortality was 4.3%. The median follow-up was 217 and 74 months for the first and second eras. Survival for earlier and later eras at 2-, 5- and 10-year follow-up was (85.1%, 81.5%, 79.6% vs 94.2%, 94.2%, 94.2% respectively, log-rank test P = 0.03). CONCLUSIONS The surgical approach to ToF-CAVC has evolved over time. More recently, patients tended to receive primary repair at younger ages and had fewer palliative procedures. Improved surgical techniques allowing for earlier and complete repair have shown a decrease in mortality, more valve-sparing procedures without an increase in total reoperations. Presented at the 37th EACTS Annual Meeting, Vienna, Austria.
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Affiliation(s)
| | - Steven J Staffa
- Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Boston, MA, USA
| | - Sitaram M Emani
- Cardiovascular Surgery Department, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Mariana Chávez
- Cardiovascular Surgery Department, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kevin G Friedman
- Cardiology Department, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David M Hoganson
- Cardiovascular Surgery Department, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | | | - Pedro J Del Nido
- Cardiovascular Surgery Department, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Christopher W Baird
- Cardiovascular Surgery Department, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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Contemporary surgical management of complete atrioventricular septal defect with tetralogy of Fallot in Japan. Gan To Kagaku Ryoho 2022; 70:835-841. [PMID: 35332445 DOI: 10.1007/s11748-022-01809-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2022] [Accepted: 03/12/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Complete atrioventricular septal defect with tetralogy of Fallot is a rare and complex heart disease. This study aimed to describe contemporary management approaches for this heart disease and the outcomes. METHODS Data were obtained from 46 domestic institutions in the Japan Cardiovascular Database (2011-2018). Patients with a fundamental diagnosis of complete atrioventricular septal defect with tetralogy of Fallot, without other complex heart diseases, were included. The primary outcome was operative mortality (30-day or in-hospital mortality). RESULTS A total of 119 patients underwent initial surgery for a complete atrioventricular septal defect with tetralogy of Fallot during this study period. Primary repair was performed in 40 (34%) patients (primary repair group), and palliative procedure was performed in 79 (66%) patients as part of a planned staged approach (staged group). Forty institutions (87%) experienced at least one case of staged repair. No institution experienced more than or equal to two cases/year on average during the study period. Overall, 11 operative mortalities occurred (9.2%). Operative mortality rates in the primary and staged groups were comparable (p = 0.5). Preoperative catecholamine use, repeat palliative surgeries, and emergency admission were significant risk factors for operative mortality in multivariate analysis (odds ratio, 95% confidence interval: 8.58, [0-0.11]; 12.65, [1.28-125.15]; 8.64, [1.87-39.32, respectively]). CONCLUSIONS Staged approach for complete atrioventricular septal defect with tetralogy of Fallot was the preferred option. The outcomes of this complex disease were favorable for patients in centers with low cases of complete atrioventricular septal defect with tetralogy of Fallot.
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Shimoda T, Mathis BJ, Kato H, Matsubara M, Suzuki Y, Suetsugu F, Hiramatsu Y. Architecture matters: Tissue preservation strategies for tetralogy of Fallot repair. J Card Surg 2021; 36:2836-2849. [PMID: 33908656 DOI: 10.1111/jocs.15584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2020] [Revised: 02/11/2021] [Accepted: 04/15/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Great variability exists in repair strategies for the tetralogy of Fallot. While transannular patching, as introduced by Kirklin, was a breakthrough for primary repair, pulmonary regurgitation and a need for reoperation have led to the development of methods that preserve the natural morphology of the right ventricular outflow tract. METHODS State-of-the-art details of tetralogy of Fallot repair are explained from the standpoint of architectural preservation, especially with regard to sparing native tissue such as the annulus, valve, or infundibulum. Particular attention is given to the latest technical details of each approach, benefits and disadvantages, and any long-term data available. RESULTS The choice of procedure is complex and unique to each case as transannular patching alone may carry long-term pulmonary risks. Modifications that spare the annulus, valves, or infundibulum may thus be essential as preservation of natural morphology has resulted in excellent mid-term results. CONCLUSIONS The complexity of tetralogy of Fallot repair demands constant attention to clinical presentation and vigilance against long-term sequelae. Techniques will continue to improve over time as long-term data guides the refinement of these innovative surgical methods.
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Affiliation(s)
- Tomonari Shimoda
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Bryan J Mathis
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Hideyuki Kato
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Muneaki Matsubara
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Yasuyuki Suzuki
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
| | - Fuminaga Suetsugu
- Department of Cardiovascular Surgery, Suetsugu Clinic , Kitakyushu, Fukuoka, Japan
| | - Yuji Hiramatsu
- Department of Cardiovascular Surgery, University of Tsukuba, Tsukuba, Ibaraki, Japan
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Abumehdi M, Al Nasef M, Mehta C, Botha P, McMahon C, Oslizlok P, Walsh KP, McCrossan B, Kenny D, Stümper O. Short to medium term outcomes of right ventricular outflow tract stenting as initial palliation for symptomatic infants with complete atrioventricular septal defect with associated tetralogy of Fallot. Catheter Cardiovasc Interv 2020; 96:1445-1453. [PMID: 33022100 DOI: 10.1002/ccd.29306] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 09/18/2020] [Accepted: 09/22/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVES To assess the impact of right ventricular outflow tract (RVOT) stenting as the primary palliation in infants with complete atrioventricular septal defect with associated tetralogy of Fallot (cAVSD/TOF). BACKGROUND Historically, palliation of symptomatic patients with cAVSD/TOF has been achieved through surgical systemic to pulmonary artery shunting. More recently RVOT stenting has evolved as an acceptable alternative in patients with tetralogy of Fallot. METHODS Retrospective review of all patients with cAVSD/TOF who underwent RVOT stenting as palliation over a 13-year period from two large tertiary referral centers. RESULTS Twenty-six patients underwent RVOT stenting at a median age of 57 days (interquartile range [IQR] 25.5-106.5). Median weight for stent deployment was 3.7 kg (IQR 2.91-5.5 kg). RVOT stenting improved oxygen saturations from a median of 72% (IQR 70-76%) to 90% (IQR 84-92%), p < .001. There was a significant increase in the median Z-score for both branch pulmonary arteries at median follow-up of 255 days (IQR 60-455). Eight patients required RVOT stent balloon dilatations and 8 patients required re-stenting for progressive desaturation. The median duration between reinterventions was 122 days (IQR 53-294 days). Four patients died during the follow-up period. No deaths resulted from the initial intervention. To date, definitive surgical intervention was achieved in 19 patients (biventricular repair n = 15) at a median age of 369 days (IQR 223-546 days). CONCLUSION RVOT stenting in cAVSD/TOF is a safe and effective palliative procedure in symptomatic infants, promoting pulmonary artery growth and improving oxygen saturations.
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Affiliation(s)
- Mohammad Abumehdi
- The Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | | | - Chetan Mehta
- The Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Phil Botha
- The Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
| | - Colin McMahon
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Paul Oslizlok
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Kevin P Walsh
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | | | - Damien Kenny
- Children's Health Ireland at Crumlin, Dublin, Ireland
| | - Oliver Stümper
- The Heart Unit, Birmingham Children's Hospital NHS Foundation Trust, Birmingham, UK
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Alhawri KA, Mcmahon CJ, Alrih MM, Alzein Y, Khan AA, Mohammed SK, Alalwi KS, Walsh KP, Kenny DP, McGuinness JG, Nolke L, Redmond JM. Atrioventricular septal defect and tetralogy of Fallot - A single tertiary center experience: A retrospective review. Ann Pediatr Cardiol 2019; 12:103-109. [PMID: 31143034 PMCID: PMC6521653 DOI: 10.4103/apc.apc_87_18] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background: Complete atrioventricular septal defect (CAVSD) in association with tetralogy of Fallot is a rare and complex disease that makes its repair more difficult than repair of either lesion alone. We reviewed retrospectively our experience in managing this lesion. Patients and Methods: Between February 2006 and May 2017, 16 patients who underwent repair of CAVSD/tetralogy of Fallot (TOF) were reviewed retrospectively. Fifteen patients had trisomy 21. Five patients underwent primary repair while eleven patients went for staged repair in the form of right ventricular outflow tract (RVOT) stenting (n = 9) or systemic to pulmonary (S-P) surgical shunt (n = 2). RVOT stenting has replaced surgical shunt since 2012 in our center. Early presentation with cyanosis was the main determinant factor for staged versus primary repair. Results: The median age at first palliation was 46 days (range 15–99 days). The median age at total repair for both groups was 6 months (range 3–18 months); the median age for the palliated patients was 6.5 months (range 5–18 months) while the median age for primary repaired patients was 5 months (range 3–11 months). The median weight at final repair was 6.9 kg (3.7–8.2 kg). The pulmonary valve was preserved in five patients (31%), four of them had no prior palliation. Chylothorax occurred in 50% of the patients. One late mortality occurred after final repair due to sepsis. Conclusion: CAVSD/TOF can be repaired with low mortality and morbidity. The use of RVOT stent has replaced the surgical (S-P) shunt with acceptable results in our center.
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Affiliation(s)
- Khaled A Alhawri
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Colin J Mcmahon
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Mohammed M Alrih
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Yamin Alzein
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Asad A Khan
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Suhaib K Mohammed
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Khaled S Alalwi
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Kevin P Walsh
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Damien P Kenny
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Jonathon G McGuinness
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - Lars Nolke
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
| | - John M Redmond
- Department of Pediatric Cardiothoracic Surgery, Our Lady's Hospital for Sick Children, Crumlin, Dublin, Ireland
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Al Haddad E, LaPar DJ, Dayton J, Stephens EH, Bacha E. Complete atrioventricular canal repair with a decellularized porcine small intestinal submucosa patch. CONGENIT HEART DIS 2018; 13:997-1004. [DOI: 10.1111/chd.12666] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2018] [Revised: 08/01/2018] [Accepted: 08/07/2018] [Indexed: 11/27/2022]
Affiliation(s)
- Eliana Al Haddad
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Damien J. LaPar
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Jeffrey Dayton
- Division of Pediatric Cardiology; NewYork-Presbyterian/Weill Cornell Medical Center; New York New York
| | - Elizabeth H. Stephens
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
| | - Emile Bacha
- Pediatric Cardiac Surgery, Department of Surgery; Morgan Stanley Children’s Hospital; Columbia University Medical Center; New York New York
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7
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Lenko E, Kulyabin Y, Zubritskiy A, Gorbatykh Y, Naberukhin Y, Nichay N, Bogachev-Prokophiev A, Karaskov A. Influence of staged repair and primary repair on outcomes in patients with complete atrioventricular septal defect and tetralogy of Fallot: a systematic review and meta-analysis. Interact Cardiovasc Thorac Surg 2018; 26:98-105. [PMID: 29049707 DOI: 10.1093/icvts/ivx267] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2017] [Accepted: 07/12/2017] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Complete atrioventricular septal defect with tetralogy of Fallot is a rare congenital heart disease. The combination of these lesions occurs in about 1% of all patients with atrioventricular canal defects and in 5-6% of patients with tetralogy of Fallot. To assess the influence of surgical strategy on the survival and reintervention rate for the left atrioventricular valve and right ventricular outflow tract. METHODS We analyzed all related studies since 1986. Thirty-eight articles were initially retrieved via PubMed/MEDLINE, Cochrane Central Register of Controlled Trials and Google Scholar, from which 18 retrospective studies were included in the systematic review and 8 studies in the meta-analysis. RESULTS There was no significant difference in the 6-year survival between staged repair and primary repair [80 patients in the primary group and 81 patients in the staged group; I2 = 0%; time-to-event data Peto odds ratio 0.66, 95% confidence interval (CI) 0.3-1.5, P = 0.31; hazard ratio 0.66, 95% CI 0.3-1.3, P = 0.23]. Both groups had an equal reintervention rate for the left atrioventricular valve [75 patients in the primary group and 71 patients in the staged group; I2 = 0.26%; the Mantel-Haenszel odds ratio 0.60, 95% CI 0.22-1.68, P = 0.33], but patients who received an initial palliation had a higher rate of reoperation on the right ventricular outflow tract [I2 = 0%; the Mantel-Haenszel odds ratio 0.27, 95% CI 0.27-0.9988, P = 0.05]. CONCLUSIONS Results of this meta-analysis reveal no difference in 6-year survival and reoperation rate for the left atrioventricular valve; however, patients who underwent staged repair had a higher rate of reintervention for the right ventricular outflow tract, which could be related to initially poor pulmonary bed anatomy. Therefore, both the primary repair and the staged repair are acceptable options for repair of complete atrioventricular septal defect with tetralogy of Fallot. The choice of surgical strategy must consider the anatomy of the pulmonary bed, patient condition and associated anomalies, which could affect surgical risk.
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Affiliation(s)
- Evgeniy Lenko
- Department of Congenital Heart Surgery, Siberian Biomedical Research Center, Novosibirsk, Russian Federation
| | - Yuriy Kulyabin
- Department of Congenital Heart Surgery, Siberian Biomedical Research Center, Novosibirsk, Russian Federation
| | - Alexey Zubritskiy
- Department of Congenital Heart Surgery, Siberian Biomedical Research Center, Novosibirsk, Russian Federation
| | - Yuriy Gorbatykh
- Department of Congenital Heart Surgery, Siberian Biomedical Research Center, Novosibirsk, Russian Federation
| | - Yuriy Naberukhin
- Department of Congenital Heart Surgery, Siberian Biomedical Research Center, Novosibirsk, Russian Federation
| | - Nataliya Nichay
- Department of Congenital Heart Surgery, Siberian Biomedical Research Center, Novosibirsk, Russian Federation
| | | | - Alexander Karaskov
- Department of Congenital Heart Surgery, Siberian Biomedical Research Center, Novosibirsk, Russian Federation
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8
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Stephens EH, Tingo J, Najjar M, Yilmaz B, Levasseur S, Dayton JD, Mosca RS, Chai P, Quaegebeur JM, Bacha EA. Cardiac Function After Tetralogy of Fallot/Complete Atrioventricular Canal Repair. World J Pediatr Congenit Heart Surg 2017; 8:189-195. [PMID: 28329461 DOI: 10.1177/2150135116682719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Repair of complete atrioventricular canal (CAVC) with tetralogy of Fallot (TOF) is a challenging operation increasingly being performed as a complete, primary repair in infancy. Previous studies have focused on perioperative outcomes; however, midterm valve function, ventricular function, and residual obstruction have received little attention. METHODS We retrospectively reviewed 20 patients who underwent CAVC/TOF repair (January 2005 to December 2014). A two-patch repair was used in all patients to correct the CAVC defect. Tetralogy of Fallot repair included transannular patch in 11 (65%) patients and valve-sparing in 6 (35%) patients. RESULTS The average age at surgery was 72 ± 122 weeks, 40% were male, and 80% had trisomy 21. Mean echo follow-up was 3.0 ± 3.0 years. There were no in-hospital or late mortalities. The rate of reoperation was 20%. At the latest follow-up, moderate left atrioventricular valve regurgitation was present in three (15%) patients and mild stenosis present in seven (35%) patients. One (5%) patient had moderate right ventricular outflow tract (RVOT) obstruction. The valve-sparing population was smaller at the time of surgery than the non-valve-sparing cohort (body surface area: 0.28 ± 0.04 vs 0.42 ± 0.11, P = .002) and less likely to have had a previous shunt (0% vs 64%, P = .01). Among the valve-sparing patients (six), at the latest follow-up, moderate pulmonary insufficiency was present in two (33%) patients. CONCLUSION Repair of CAVC concomitant with TOF can be performed with low mortality and acceptable perioperative morbidity. Management of the RVOT remains a challenge for the long term.
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Affiliation(s)
- Elizabeth H Stephens
- 1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jennifer Tingo
- 2 Division of Cardiology, St Christopher's Hospital for Children, Philadelphia, PA, USA
| | - Marc Najjar
- 1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Betul Yilmaz
- 3 Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Stéphanie Levasseur
- 4 Division of Pediatric Cardiology, Columbia University Medical Center, New York, NY, USA
| | | | - Ralph S Mosca
- 6 Department of Cardiothoracic Surgery, New York University, New York, NY, USA
| | - Paul Chai
- 1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Jan M Quaegebeur
- 1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
| | - Emile A Bacha
- 1 Division of Cardiac, Thoracic, and Vascular Surgery, Columbia University Medical Center, New York, NY, USA
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Affiliation(s)
- Edvin Prifti
- Division of Cardiac Surgery, University Hospital Center of Tirana, Albania
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10
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Pavy C, Ghez O. Surgical repair of a complete atrioventricular septal defect with tetralogy of Fallot using a classical one-patch technique and pulmonary valve preservation. Multimed Man Cardiothorac Surg 2016; 2017:mmw014. [PMID: 28106970 DOI: 10.1093/mmcts/mmw014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The association of complete atrial ventricular septal defect (cAVSD) with tetralogy of Fallot remains a complex malformation that involves both inlet and outlet components of the ventricles. The surgical treatment used to be, in the 1980s, a staged repair strategy due to the high mortality rate of first primary repairs (PRs). However, nowadays, PRs have better outcomes. Although double-patch procedures are widely performed, this article describes the single-patch approach for cAVSD repair with transatrial-transpulmonary repair of the Fallot component with preservation of the pulmonary valve.
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11
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Nguyen HH, Jay PY. A single misstep in cardiac development explains the co-occurrence of tetralogy of fallot and complete atrioventricular septal defect in Down syndrome. J Pediatr 2014; 165:194-6. [PMID: 24721467 PMCID: PMC4074567 DOI: 10.1016/j.jpeds.2014.02.065] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2013] [Revised: 01/27/2014] [Accepted: 02/19/2014] [Indexed: 11/17/2022]
Abstract
Tetralogy of Fallot and a complete atrioventricular septal defect are thought to arise by distinct mechanisms, yet their co-occurrence is a recognized association. Analysis of the prevalence of co-occurrence in Down syndrome suggests a common developmental basis. Trisomy 21 may perturb cardiac progenitor cells before they enter the heart tube.
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Affiliation(s)
- Hoang H Nguyen
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO
| | - Patrick Y Jay
- Department of Pediatrics, Washington University School of Medicine, St. Louis, MO; Department of Genetics, Washington University School of Medicine, St. Louis, MO.
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Morimoto K, Hoashi T, Kagisaki K, Kurosaki K, Shiraishi I, Ichikawa H. Post-operative left atrioventricular valve function after the staged repair of complete atrioventricular septal defect with tetralogy of Fallot. Gen Thorac Cardiovasc Surg 2014; 62:602-7. [DOI: 10.1007/s11748-014-0411-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2014] [Accepted: 04/18/2014] [Indexed: 10/25/2022]
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13
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Hu R, Zhang H, Xu Z, Liu J, Su Z, Ding W. Surgical Management of Complete Atrioventricular Septal Defect with Tetralogy of Fallot. Ann Thorac Cardiovasc Surg 2014; 20:341-6. [DOI: 10.5761/atcs.oa.12-02198] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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14
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Raju V, Burkhart HM, Rigelman Hedberg N, Eidem BW, Li Z, Connolly H, Schaff HV, Dearani JA. Surgical Strategy for Atrioventricular Septal Defect and Tetralogy of Fallot or Double-Outlet Right Ventricle. Ann Thorac Surg 2013; 95:2079-84; discussion 2084-5. [DOI: 10.1016/j.athoracsur.2013.02.016] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2012] [Revised: 01/28/2013] [Accepted: 02/04/2013] [Indexed: 10/26/2022]
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Kotani Y, Chetan D, Ono N, Mertens LL, Caldarone CA, Van Arsdell GS, Honjo O. Late functional outcomes after repair of tetralogy of Fallot with atrioventricular septal defect: A double case-match control study. J Thorac Cardiovasc Surg 2013; 145:1477-84, 1484.e1-4. [DOI: 10.1016/j.jtcvs.2013.01.007] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/29/2012] [Revised: 12/04/2012] [Accepted: 01/11/2013] [Indexed: 11/30/2022]
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Tetralogy of Fallot with atrioventricular septal defect: surgical strategies for repair and midterm outcome of pulmonary valve-sparing approach. Pediatr Cardiol 2013; 34:861-71. [PMID: 23104595 DOI: 10.1007/s00246-012-0558-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2012] [Accepted: 10/04/2012] [Indexed: 01/25/2023]
Abstract
Repair for tetralogy of Fallot (TOF) with complete atrioventricular septal defect (CAVSD) has been reported with good early and intermediate outcomes. Morbidity, however, remains significantly high. To date, repair of CAVSD/TOF using a pulmonary valve-sparing technique (PVS) and freedom from valve reoperation are not well defined. A study was undertaken to investigate outcomes. This study was conducted in as a retrospective investigation. Between January 1988 and December 2008, 13 consecutive patients with CAVSD/TOF were identified, and their records were reviewed retrospectively. Of these 13 patients, 9 had Rastelli type C CAVSD. Trisomy 21 was present in 9 cases (69 %; 7 with type C). Five patients had received a systemic-to-pulmonary shunt (SPS) before complete repair at a mean age 1.7 ± 0.6 months. All the patients survived until complete repair. At complete CAVSD/TOF repair, AVSD was corrected with a two-patch technique in all patients. For eight patients (61.5 %), PVS was used. The remaining five patients had transannular patch (TAP) repair. The mean age at complete repair was 6.3 ± 2.4 months. At complete repair, the mean cardiopulmonary bypass time was 173.5 ± 30.6 min, and the cross-clamp time was 134.7 ± 28.8 min. There was one hospitalization and no late deaths. The median follow-up period was 9.2 years [interquartile range (IQR), 4.7-13.3 years]. The actuarial survival was 90.0 ± 9.5 % at 1 year, 90 ± 9.5 % at 5 years, and 90 ± 9.5 % at 8 years. Of the 12 survivors, 6 had some reintervention during the follow-up period. Within the first 11 years after complete repair, two patients underwent left atrioventricular (AV) valve repair, and one patient had right AV valve repair. Two patients had residual VSD closure. Four patients underwent the first right ventricular outflow tract (RVOT) reintervention for critical insufficiency or stenosis at a mean interval of 6 ± 21) months. One patient had a second RVOT reoperation. Findings showed that CAVSD/TOF with PVS was related to significantly higher freedom from RVOT reintervention (100 % at 1, 5, and 8 years compared with 80 ± 17.9 % at 1 year, 60 ± 21.9 % at 5 years, and 40 ± 21.9 % at 8 years for CAVSD/TOF using TAP; P < 0.05). No patient who underwent PVS had left ventricular outflow tract obstruction requiring reoperation. Overall freedom from any reintervention was 90.9 ± 8.6 % at 1 year, 71.6 ± 14.0 % at 5 years, and 53.7 ± 8.7 % at 8 years in this group of patients. Correction of TOF with CAVSD can be performed at low risk with favorable intermediate-term survival and satisfactory freedom from reoperation. Use of TAP can be avoided in almost two thirds of patients and may influence freedom from early RVOT reintervention.
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Ong J, Brizard CP, d'Udekem Y, Weintraub R, Robertson T, Cheung M, Konstantinov IE. Repair of atrioventricular septal defect associated with tetralogy of Fallot or double-outlet right ventricle: 30 years of experience. Ann Thorac Surg 2012; 94:172-8. [PMID: 22588011 DOI: 10.1016/j.athoracsur.2012.02.070] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2011] [Revised: 02/19/2012] [Accepted: 02/23/2012] [Indexed: 10/28/2022]
Abstract
BACKGROUND The surgical outcomes of atrioventricular septal defect (AVSD) associated with tetralogy of Fallot (TOF) or double-outlet right ventricle (DORV) have improved in recent times. However, high mortality and reoperation rates are still reported. This study reviews our surgical experience in patients with complete AVSD and TOF or DORV. METHODS Between 1980 and 2010, 48 consecutive patients with AVSD associated with TOF (n = 26) or DORV (n = 22) underwent complete repair; of which, 19 had staged repair. A transatrial-transpulmonary approach with the 2-patch technique was the preferred surgical technique. Data were obtained from inpatient and outpatient medical files. RESULTS The mortality rates were 8.3% (4 of 48) for in-hospital death and 13.6% (6 of 44) for late death. Mean follow-up was 8.0 ± 8.7 years (median 10.8 years; range from 2 months to 30 years). Actuarial survival was 76% at 5 years and 71% at 20 years. No deaths occurred after 2001. Reoperations were required in 16 of 48 patients (33%). The overall freedom from reoperation was 55% at 5 and 20 years. Down syndrome was protective for reoperation (p = 0.022). CONCLUSIONS Complete AVSD associated with TOF or DORV can be repaired with good survival. Detachment of the superior bridging leaflet provided excellent exposure. However, reoperation rate remains high.
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Affiliation(s)
- Jeremy Ong
- Royal Children's Hospital, University of Melbourne, Melbourne, Victoria, Australia
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Shuhaiber JH, Robinson B, Gauvreau K, Breitbart R, Mayer JE, Del Nido PJ, Pigula F. Outcome after repair of atrioventricular septal defect with tetralogy of Fallot. J Thorac Cardiovasc Surg 2011; 143:338-43. [PMID: 21855095 DOI: 10.1016/j.jtcvs.2011.05.031] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2010] [Revised: 04/04/2011] [Accepted: 05/05/2011] [Indexed: 11/29/2022]
Abstract
BACKGROUND Long-term outcomes of repair of tetralogy of Fallot associated with complete atrioventricular septal defect are seldom reported. We report our survival and reintervention outcomes over a 29-year time period. METHODS Between March 1979 and April 2008, 61 patients with the combined cardiac defect of atrioventricular septal defect and tetralogy of Fallot were surgically managed. Trisomy 21 was present in 49 (80%) patients. Primary repair was performed in 36 patients at a median age of 9 months (range, 1 month to 16 years), whereas 25 patients had initial palliation by systemic-pulmonary shunt at a median age of 21 months (range, 0 days to 36 years). Thirty-one (51%) patients had a transannular patch. Fifty-three patients required right ventriculotomy for relief of the right ventricular outflow tract obstruction. Four patients had a right ventricle-pulmonary artery conduit with a homograft. Relationships between patient characteristics and outcome variables were examined using Kaplan-Meier survival curves; comparisons were performed using the log-rank test. RESULTS Median follow-up was 4.7 years. A total of 12 patients died during the course of follow-up: 4 (7%)deaths within 30 days of surgery and 8 late deaths (range, 4 months to 9.9 years after repair). Since 2000, there have been no early deaths and 1 late death, 5 months after the operation. The estimated survival at 5 years after definitive repair was 82% (95% confidence interval, 69%, 90%). Time to death was not associated with any patient or surgical variables examined. Overall, 30% of the survivors required a reoperation. The type of reoperations was on the mitral valve (4 repairs, 4 replacements) and 7 pulmonary valve replacements. We did not find an effect of era on mortality (P = .23 for comparison of 1979-1989, 1990-1999, and 2000-2008). The percentage of patients with primary repair did not change during the different quartiles. The estimated freedom from reoperation at 5 years was 80% (65%, 90%). Time to reoperation was shorter for patients with a conduit (P = .01). CONCLUSIONS Excellent long-term survival was achieved after repair of tetralogy of Fallot associated with complete atrioventricular septal defect. Palliation and primary repair resulted in comparable outcomes; as such, primary repair is favored. The choice of right ventricular outflow tract reconstruction affects the need for reoperation.
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Affiliation(s)
- Jeffrey H Shuhaiber
- Department of Cardiovascular Surgery, Children's Hospital Boston, Boston, Mass., USA.
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Kestelli M, Yurekli I, Gurbuz A. Is a transannular patch always necessary? J Thorac Cardiovasc Surg 2010; 139:1360-1; author reply 1361. [PMID: 20412977 DOI: 10.1016/j.jtcvs.2009.12.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 12/28/2009] [Indexed: 11/26/2022]
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