Surgery following primary right ventricular outflow tract stenting for Fallot's Tetralogy and variants: Rehabilitation of small pulmonary arteries

David J. Barron, Bharat Ramchandani, John Murala, Oliver Stumper, Joseph V. De Giovanni, Timothy J. Jones, John Stickley, William J. Brawn

Research output: Contribution to journalArticle

26 Citations (Scopus)

Abstract

OBJECTIVES: Primary surgical repair of Tetralogy of Fallot (ToF) in small infants with small pulmonary arteries (PAs) or complex anatomies can be hazardous. We assessed the effect of right ventricular outflow tract (RVOT) stenting on subsequent surgical intervention with attention to growth of the PAs. METHODS: Primary RVOT stenting was performed in 32 symptomatic patients with ToF physiology. Twenty patients had surgical intervention, with 15 undergoing complete repair to date. Median age at stenting was 61 (range 8-406) days, and median weight, 3.9 (range 1.8-12.2) kg. RESULTS: Stenting improved saturations from 72 ± 8 to 92 ± 2% (P < 0.001). Four patients required early surgical palliation for persistent desaturation (within 4 weeks). Twenty patients went on to have surgical intervention at a median time of 220 days after stenting. There was no operative mortality after complete repair. Removing the stent lengthened the procedure time and 86% required transannular patch (TAP; bypass time 109 ± 42 min, cross clamp 68 ± 29 min). Median intensive therapy unit stay was 2 days. There was 1 late death at 3 months due to chronic lung disease. The median left PA Z-score increased from a preinterventional value of -1.27 (-0.19 to -2.87) to a presurgical value of +0.11 (-4.12 to +1.97). The median right PA Z-score increased from -2.02 (-1.77 to -4.68) to -0.65 (-0.29 to -2.04) over the preinterventional and presurgical time intervals. Growth was greatest in the right PA. CONCLUSIONS: Primary RVOT stenting facilitates staged palliation for ToF in small infants and complex anatomies. Improved PA blood flow generated by the stent leads to growth of the branch PAs and may improve the substrate for subsequent surgical repair. Surgery is safe; however, the majority will require a TAP.

Original languageEnglish (US)
Article numberezt188
Pages (from-to)656-662
Number of pages7
JournalEuropean Journal of Cardio-thoracic Surgery
Volume44
Issue number4
DOIs
StatePublished - Jan 1 2013

Fingerprint

Tetralogy of Fallot
Pulmonary Artery
Rehabilitation
Stents
Anatomy
Growth
Lung Diseases
Chronic Disease
Weights and Measures
Mortality

Keywords

  • Right ventricular outflow tract
  • Stenting
  • Tetrology of fallot

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Surgery following primary right ventricular outflow tract stenting for Fallot's Tetralogy and variants : Rehabilitation of small pulmonary arteries. / Barron, David J.; Ramchandani, Bharat; Murala, John; Stumper, Oliver; De Giovanni, Joseph V.; Jones, Timothy J.; Stickley, John; Brawn, William J.

In: European Journal of Cardio-thoracic Surgery, Vol. 44, No. 4, ezt188, 01.01.2013, p. 656-662.

Research output: Contribution to journalArticle

Barron, David J. ; Ramchandani, Bharat ; Murala, John ; Stumper, Oliver ; De Giovanni, Joseph V. ; Jones, Timothy J. ; Stickley, John ; Brawn, William J. / Surgery following primary right ventricular outflow tract stenting for Fallot's Tetralogy and variants : Rehabilitation of small pulmonary arteries. In: European Journal of Cardio-thoracic Surgery. 2013 ; Vol. 44, No. 4. pp. 656-662.
@article{d4ed5b0bf7dc482d8dd7fb08ff76a967,
title = "Surgery following primary right ventricular outflow tract stenting for Fallot's Tetralogy and variants: Rehabilitation of small pulmonary arteries",
abstract = "OBJECTIVES: Primary surgical repair of Tetralogy of Fallot (ToF) in small infants with small pulmonary arteries (PAs) or complex anatomies can be hazardous. We assessed the effect of right ventricular outflow tract (RVOT) stenting on subsequent surgical intervention with attention to growth of the PAs. METHODS: Primary RVOT stenting was performed in 32 symptomatic patients with ToF physiology. Twenty patients had surgical intervention, with 15 undergoing complete repair to date. Median age at stenting was 61 (range 8-406) days, and median weight, 3.9 (range 1.8-12.2) kg. RESULTS: Stenting improved saturations from 72 ± 8 to 92 ± 2{\%} (P < 0.001). Four patients required early surgical palliation for persistent desaturation (within 4 weeks). Twenty patients went on to have surgical intervention at a median time of 220 days after stenting. There was no operative mortality after complete repair. Removing the stent lengthened the procedure time and 86{\%} required transannular patch (TAP; bypass time 109 ± 42 min, cross clamp 68 ± 29 min). Median intensive therapy unit stay was 2 days. There was 1 late death at 3 months due to chronic lung disease. The median left PA Z-score increased from a preinterventional value of -1.27 (-0.19 to -2.87) to a presurgical value of +0.11 (-4.12 to +1.97). The median right PA Z-score increased from -2.02 (-1.77 to -4.68) to -0.65 (-0.29 to -2.04) over the preinterventional and presurgical time intervals. Growth was greatest in the right PA. CONCLUSIONS: Primary RVOT stenting facilitates staged palliation for ToF in small infants and complex anatomies. Improved PA blood flow generated by the stent leads to growth of the branch PAs and may improve the substrate for subsequent surgical repair. Surgery is safe; however, the majority will require a TAP.",
keywords = "Right ventricular outflow tract, Stenting, Tetrology of fallot",
author = "Barron, {David J.} and Bharat Ramchandani and John Murala and Oliver Stumper and {De Giovanni}, {Joseph V.} and Jones, {Timothy J.} and John Stickley and Brawn, {William J.}",
year = "2013",
month = "1",
day = "1",
doi = "10.1093/ejcts/ezt188",
language = "English (US)",
volume = "44",
pages = "656--662",
journal = "European Journal of Cardio-thoracic Surgery",
issn = "1010-7940",
publisher = "Elsevier",
number = "4",

}

TY - JOUR

T1 - Surgery following primary right ventricular outflow tract stenting for Fallot's Tetralogy and variants

T2 - Rehabilitation of small pulmonary arteries

AU - Barron, David J.

AU - Ramchandani, Bharat

AU - Murala, John

AU - Stumper, Oliver

AU - De Giovanni, Joseph V.

AU - Jones, Timothy J.

AU - Stickley, John

AU - Brawn, William J.

PY - 2013/1/1

Y1 - 2013/1/1

N2 - OBJECTIVES: Primary surgical repair of Tetralogy of Fallot (ToF) in small infants with small pulmonary arteries (PAs) or complex anatomies can be hazardous. We assessed the effect of right ventricular outflow tract (RVOT) stenting on subsequent surgical intervention with attention to growth of the PAs. METHODS: Primary RVOT stenting was performed in 32 symptomatic patients with ToF physiology. Twenty patients had surgical intervention, with 15 undergoing complete repair to date. Median age at stenting was 61 (range 8-406) days, and median weight, 3.9 (range 1.8-12.2) kg. RESULTS: Stenting improved saturations from 72 ± 8 to 92 ± 2% (P < 0.001). Four patients required early surgical palliation for persistent desaturation (within 4 weeks). Twenty patients went on to have surgical intervention at a median time of 220 days after stenting. There was no operative mortality after complete repair. Removing the stent lengthened the procedure time and 86% required transannular patch (TAP; bypass time 109 ± 42 min, cross clamp 68 ± 29 min). Median intensive therapy unit stay was 2 days. There was 1 late death at 3 months due to chronic lung disease. The median left PA Z-score increased from a preinterventional value of -1.27 (-0.19 to -2.87) to a presurgical value of +0.11 (-4.12 to +1.97). The median right PA Z-score increased from -2.02 (-1.77 to -4.68) to -0.65 (-0.29 to -2.04) over the preinterventional and presurgical time intervals. Growth was greatest in the right PA. CONCLUSIONS: Primary RVOT stenting facilitates staged palliation for ToF in small infants and complex anatomies. Improved PA blood flow generated by the stent leads to growth of the branch PAs and may improve the substrate for subsequent surgical repair. Surgery is safe; however, the majority will require a TAP.

AB - OBJECTIVES: Primary surgical repair of Tetralogy of Fallot (ToF) in small infants with small pulmonary arteries (PAs) or complex anatomies can be hazardous. We assessed the effect of right ventricular outflow tract (RVOT) stenting on subsequent surgical intervention with attention to growth of the PAs. METHODS: Primary RVOT stenting was performed in 32 symptomatic patients with ToF physiology. Twenty patients had surgical intervention, with 15 undergoing complete repair to date. Median age at stenting was 61 (range 8-406) days, and median weight, 3.9 (range 1.8-12.2) kg. RESULTS: Stenting improved saturations from 72 ± 8 to 92 ± 2% (P < 0.001). Four patients required early surgical palliation for persistent desaturation (within 4 weeks). Twenty patients went on to have surgical intervention at a median time of 220 days after stenting. There was no operative mortality after complete repair. Removing the stent lengthened the procedure time and 86% required transannular patch (TAP; bypass time 109 ± 42 min, cross clamp 68 ± 29 min). Median intensive therapy unit stay was 2 days. There was 1 late death at 3 months due to chronic lung disease. The median left PA Z-score increased from a preinterventional value of -1.27 (-0.19 to -2.87) to a presurgical value of +0.11 (-4.12 to +1.97). The median right PA Z-score increased from -2.02 (-1.77 to -4.68) to -0.65 (-0.29 to -2.04) over the preinterventional and presurgical time intervals. Growth was greatest in the right PA. CONCLUSIONS: Primary RVOT stenting facilitates staged palliation for ToF in small infants and complex anatomies. Improved PA blood flow generated by the stent leads to growth of the branch PAs and may improve the substrate for subsequent surgical repair. Surgery is safe; however, the majority will require a TAP.

KW - Right ventricular outflow tract

KW - Stenting

KW - Tetrology of fallot

UR - http://www.scopus.com/inward/record.url?scp=84896955401&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84896955401&partnerID=8YFLogxK

U2 - 10.1093/ejcts/ezt188

DO - 10.1093/ejcts/ezt188

M3 - Article

C2 - 23650024

AN - SCOPUS:84896955401

VL - 44

SP - 656

EP - 662

JO - European Journal of Cardio-thoracic Surgery

JF - European Journal of Cardio-thoracic Surgery

SN - 1010-7940

IS - 4

M1 - ezt188

ER -