REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE “TRANSATRIAL-TRANSPULMONARY APPROACH” Vladimiro Vida, M.D. University of Padua - Italy Department of Cardiovascular Surgery
Welcome message from author
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE
MONTHS OF LIFE
“TRANSATRIAL-TRANSPULMONARY APPROACH”
Vladimiro Vida, M.D.
University of Padua - ItalyDepartment of Cardiovascular Surgery
Department of Cardiovascular Surgery University of Padua - Italy
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Period: January 1991 – December 2001
20 males35 pts (< 3 months of age)
15 females
Excluded: TOF + AVSD TOF + APVSTOF + PA TOF + DORV
Department of Cardiovascular Surgery University of Padua - Italy
SURGICAL TECHNIQUES (1)
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
TRANSATRIAL- TRANSPULMONARY APPROACH
•TRANSATRIAL-TRANSPULMONARY
MYOTOMY/ MYECTOMY (RESECTION OF
PARIETAL EXTENSION OF INFUNDIBULAR
SEPTUM)
•NO VENTRICULOTOMY (OR MINIMAL=5-6 mm)
•TRANSATRIAL VSD CLOSURE
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Department of Cardiovascular Surgery University of Padua - Italy
SURGICAL TECHNIQUES (2)
TYPE OF RVOT RECONSTRUCTION
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Pts
MONOCUSP TAP 20 (57.2%)(HOMOGRAFT)
AUTOLOGOUS PERIC. TAP 11 (31.4%)
NO PATCH 4 (11.4%)
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Department of Cardiovascular Surgery University of Padua - Italy
SURGICAL TECHNIQUES (3)
ASSOCIATED SURGICAL PROCEDURES
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
n°
LPA PLASTY 3
LPA from descending aorta reimplantation 1
Department of Cardiovascular Surgery University of Padua - Italy
INTRAOPERATIVE ECHOCARDIOGRAPHY
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
•EPICARDIAL IN ALL
•POST OPERATIVE EVALUATION FOR VSD, OBSTRUCTION, VENTRICULAR FUNCTION
Department of Cardiovascular Surgery University of Padua - Italy
INTRAOPERATIVE RV/LV GRADIENT (mmHg)
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
RV/LV < 0.4 IN ALL
Department of Cardiovascular Surgery University of Padua - Italy
SURGICAL RESULTS
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
1 HOSPITAL DEATH (2.8%)
CAUSE: LAD FROM RCA DISTORTION
Department of Cardiovascular Surgery University of Padua - Italy
MAJOR POSTOPERATIVE SEQUELAE
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Pts
- LOS3
•Inotropes infusion for > 48 hrs2
•ECMO support for 41 days1
- Prolonged intubation > 7 days1
Department of Cardiovascular Surgery University of Padua - Italy
FOLLOW UP (1)
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
2 months – 10.2 years (mean 3.6 years)
NO LATE DEATHSNO LATE DEATHS
34 Pts are asymptomatic in NYHA class I
Department of Cardiovascular Surgery University of Padua - Italy
FOLLOW UP (2)
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
LATE REOPERATIONS (3 pts - 8.5%)
Pts Interval (months)
Residual RVOTO 1 74
Residual RVOTO + LPA sten.1 5
Residual LPA stenosis 1 49
No reoperations for residual VSD
Department of Cardiovascular Surgery University of Padua - Italy
FOLLOW UP (3)
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
LATE REINTERVENTIONS (4 pts - 11.7%)
Pts
LPA balloon dilatation 4*
* 1 pt LPA from desc. aorta
Department of Cardiovascular Surgery University of Padua - Italy
FOLLOW UP (4)
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
% survival97.1%
020406080100
0 2 4 6 8 10
years
%
97.1%
Department of Cardiovascular Surgery University of Padua - Italy
FOLLOW UP (5)
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Freedom from reintervention
82.2%
020406080100
0 2 4 6 8 10
years
%
97.1% 92%82.2%
Department of Cardiovascular Surgery University of Padua - Italy
ECHOCARDIOGRAPHIC FOLLOW UP
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Pts phPeripheral PA branch stenosis
moderate 2
RV pressure > 40 mmHg 2
PVR absent/mild 32
PVR moderate 2
Department of Cardiovascular Surgery University of Padua - Italy
COMMENT (1)
Transatrial – Transpulmonary approach can be applied in early infancy with low operative risk, good early hemodynamic results and low incidence of residual lesions
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Department of Cardiovascular Surgery University of Padua - Italy
COMMENT (2)
The use of monocusp pulmonary Homograft patch in patients requiring transannular patch seems to minimize pulmonary regurgitation, RV failure, improving the early postoperative course
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Department of Cardiovascular Surgery University of Padua - Italy
COMMENT (3)
Echocardiographic data at the follow-up suggest that RV geometry and function is better preserved when a transatrial - transpulmonary approach is employed as compared to a “classic” transventricular approachG. Stellin, O. Milanesi et al.Ann thorac Surg, 60:588-91, 1995
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Department of Cardiovascular Surgery University of Padua - Italy
COMMENT (4)
The higher incidence of transanular patch in this age group is justified by the severity of this malformation, in most of our cases
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Department of Cardiovascular Surgery University of Padua - Italy
COMMENT (5)
We believe that early repair of congenital heart anomalies neutralizes secondary damage to vital organs improving the quality of life, in the long term
REPAIR OF TETRALOGY OF FALLOT IN THE FIRST THREE MONTHS OF LIFE
Universa Universis Patavina LibertasUniversa Universis Patavina Libertas
University of PaduaUniversity of Padua