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

Autor:	Lenoir M; Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France., Fouilloux V; Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France., Desnous B; Department of Pediatric neurology, Timone, APHM, Marseille, France., Rahmani B; Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France., El Gueddari N; Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France., Ovaert C; Department of Pediatric Cardiology, Timone, APHM, Marseille, France., Aries E; Department of Pediatric Cardiology, Timone, APHM, Marseille, France., El Louali F; Department of Pediatric Cardiology, Timone, APHM, Marseille, France., Aldebert P; Department of Pediatric Cardiology, Timone, APHM, Marseille, France., Metras D; Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France., Macé L; Department of Pediatric Cardiac Surgery, Timone, APHM, Marseille, France.
Jazyk:	angličtina
Zdroj:	Cardiology in the young [Cardiol Young] 2020 Nov; Vol. 30 (11), pp. 1679-1687. Date of Electronic Publication: 2020 Aug 18.
DOI:	10.1017/S1047951120002553
Abstrakt:	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.
Databáze:	MEDLINE
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