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Pulmonary atresia with ventricular septal defect and tetralogy of Fallot: transannular path augmentation versus systemic to pulmonary artery shunt for first-stage palliation

Published online by Cambridge University Press:  18 August 2020

Marien Lenoir Open the ORCID record for Marien Lenoir [Opens in a new window] ,
Virginie Fouilloux ,
Beatrice Desnous ,
Bilal Rahmani ,
Nabila El Gueddari ,
Caroline Ovaert ,
Edouard Aries ,
Fedoua El Louali ,
Philippe Aldebert  and
Dominique Metras
...Show all authors
Marien Lenoir*
Affiliation:
Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France
Virginie Fouilloux
Affiliation:
Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France
Beatrice Desnous
Affiliation:
Department of Pediatric neurology, Timone, APHM, Marseille, France
Bilal Rahmani
Affiliation:
Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France
Nabila El Gueddari
Affiliation:
Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France
Caroline Ovaert
Affiliation:
Department of Pediatric Cardiology, Timone, APHM, Marseille, France
Edouard Aries
Affiliation:
Department of Pediatric Cardiology, Timone, APHM, Marseille, France
Fedoua El Louali
Affiliation:
Department of Pediatric Cardiology, Timone, APHM, Marseille, France
Philippe Aldebert
Affiliation:
Department of Pediatric Cardiology, Timone, APHM, Marseille, France
Dominique Metras
Affiliation:
Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France
Loic Macé
Affiliation:
Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France
*
Author for correspondence: Marien Lenoir, Chirurgie Cardiaque Pédiatrique Hôpital de la Timone, 264 rue st Pierre 13385Marseille, France. Tel: + 33 (0) 491 386 675 Fax : + 33 (0) 491 384 576. E-mail : lenoirmarien@gmail.com
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Abstract

Background:

Pulmonary atresia with ventricular septal defect and severe tetralogy of Fallot require a palliative procedure for pulmonary artery rehabilitation. For first-stage palliation, two main surgical options are still debated: right ventricle to pulmonary artery connection and modified Blalock–Taussig shunt. We compared the clinical outcomes of the two procedures.

Methods:

From 1995 to 2018, 88 patients needed palliation (pulmonary atresia with ventricular septal defect n = 47; tetralogy of Fallot n = 41). Among these patients, 70 modified Blalock–Taussig shunt and 18 transannular path augmentation were performed before 6 months of age. Using a 1:1 propensity score match analysis, 20 patients were included in the analysis. The primary outcome was in-hospital mortality and pulmonary artery growth.

Results:

After matching, the pre-operative Nakata was smaller in transannular path augmentation 54 ± 24 mm2/m2 than modified Blalock–Taussig shunt 109 ± 31 mm2/m2 (p < 0.001). The age and weight were similar (p = 0.31 and p = 0.9, respectively). There was no difference in in-hospital mortality (p = 0.3). The Nakata index before biventricular repair and delta Nakata were smaller in modified Blalock–Taussig shunt group (206 ± 80 mm2/m2, 75 ± 103 mm2/m2) than transannular path augmentation (365 ± 170 mm2/m2, 214 ± 165 mm2/m2; p = 0.03; p < 0.001). Median time to biventricular repair was similar (p = 0.46). The rate of interstage reintervention was similar (p = 0.63).

Conclusions:

The transannular path augmentation is better for the rehabilitation of the native pulmonary artery. Despite a smaller pulmonary artery, right ventricle to pulmonary artery connection is equivalent to modified Blalock–Taussig shunt for rate of biventricular repair and time to biventricular repair.

Keywords

Pulmonary atresia with ventricular septal defectMajor aortopulmonary collateralsPalliative surgeryBlalock–Taussig shunt
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1679 - 1687
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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Footnotes

Presented at the 33rd Annual Meeting of the European Association for Cardio-Thoracic Surgery, Lisbon, Portugal, October 3–5, 2019.

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