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Tetralogy of Fallot: stent palliation or neonatal repair?

Part of: Surgery Tetralogy of Fallot (TOF) Echocardiography Interventional Cardiology

Published online by Cambridge University Press:  08 March 2021

Adeolu Banjoko ,
Golnoush Seyedzenouzi ,
James Ashton ,
Fatemeh Hedayat ,
Natalia N. Smith ,
Henry Nixon ,
Abdulla Tarmahomed ,
Amr Ashry  and
Amer Harky Open the ORCID record for Amer Harky [Opens in a new window]
Adeolu Banjoko
Affiliation:
College of Medical and Dental Sciences, University of Birmingham, Birmingham, UK
Golnoush Seyedzenouzi
Affiliation:
St. George’s University of London, Cranmer Terrace, London, UK
James Ashton
Affiliation:
School of Medicine, University of Liverpool, Cedar House, Ashton Street, Liverpool, UK
Fatemeh Hedayat
Affiliation:
School of Medicine and Dentistry, University of Central Lancashire, UK
Natalia N. Smith
Affiliation:
St. George’s University of London, Cranmer Terrace, London, UK
Henry Nixon
Affiliation:
St. George’s University of London, Cranmer Terrace, London, UK
Abdulla Tarmahomed
Affiliation:
Department of Paediatric Cardiology, Alder Hey Children’s Hospital, Liverpool, UK
Amr Ashry
Affiliation:
Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK Department of Cardiothoracic Surgery, Assiut University Hospital, Assiut, Egypt
Amer Harky*
Affiliation:
Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK Department of Cardiothoracic Surgery, Liverpool Heart and Chest Hospital, Liverpool, UK Liverpool Centre for Cardiovascular Science, University of Liverpool and Liverpool Heart and Chest Hospital, UK
*
Author for correspondence: Amer Harky, MSc, MRCS, Department of Cardiac Surgery, Alder Hey Children Hospital, Liverpool, UK. Tel: +44-151-228-4811. E-mail: amer.harky@lhch.nhs.uk
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Abstract

Surgical repair of Tetralogy of Fallot has excellent outcomes, with over 90% of patients alive at 30 years. The ideal time for surgical repair is between 3 and 11 months of age. However, the symptomatic neonate with Tetralogy of Fallot may require earlier intervention: either a palliative intervention (right ventricular outflow tract stent, ductal stent, balloon pulmonary valvuloplasty, or Blalock-Taussig shunt) followed by a surgical repair later on, or a complete surgical repair in the neonatal period. Indications for palliation include prematurity, complex anatomy, small pulmonary artery size, and comorbidities. Given that outcomes after right ventricular outflow tract stent palliation are particularly promising – there is low mortality and morbidity, and consistently increased oxygen saturations and increased pulmonary artery z-scores – it is now considered the first-line palliative option. Disadvantages of right ventricular outflow tract stenting include increased cardiopulmonary bypass time at later repair and the stent preventing pulmonary valve preservation. However, neonatal surgical repair is associated with increased short-term complications and hospital length of stay compared to staged repair. Both staged repair and primary repair appear to have similar long-term mortality and morbidity, but more evidence is needed assessing long-term outcomes for right ventricular outflow tract stent palliation patients.

Keywords

Tetralogy of Fallotsurgical repairstentpalliationneonatal repair
Type
Original Article
Information
Cardiology in the Young , Volume 31 , Issue 10 , October 2021 , pp. 1658 - 1666
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

*

These authors equally contributed to the work.

References

Bailliard, F, Anderson, RH. Tetralogy of Fallot. Orphanet J Rare Dis 2009; 4: 2.CrossRefGoogle ScholarPubMed
Apitz, C, Webb, GD, Redington, AN. Tetralogy of Fallot. Lancet 2009; 374: 1462–1471.CrossRefGoogle ScholarPubMed
Nawa, T, Murakami, T, Shiraishi, M, et al. The hemodynamic change by squatting is induced by dimished vascular distensibility and enhanced pressure wave reflection. J Hypertens 2016; 34: e240.CrossRefGoogle Scholar
Pigula, FA, Khalil, PN, Mayer, JE, et al. Repair of tetralogy of Fallot in neonates and young infants. Circulation 1999. https://doi.org/10.1161/01.cir.100.suppl_2.ii-157 CrossRefGoogle ScholarPubMed
Forman, J, Beech, R, Slugantz, L, et al. A review of tetralogy of Fallot and postoperative management. Crit Care Nurs Clin North Am 2019; 31: 315–328.CrossRefGoogle ScholarPubMed
Hill, GD, Block, JR, Tanem, JB, et al. Disparities in the prenatal detection of critical congenital heart disease. Prenat Diagn 2015; 35: 859–863.CrossRefGoogle ScholarPubMed
Ward, P, Soothill, P. Fetal anomaly ultrasound scanning: the development of a national programme for England. Obstet Gynaecol 2011; 13: 211–217.Google Scholar
Pepas, LP, Savis, A, Jones, A, et al. An echocardiographic study of tetralogy of Fallot in the fetus and infant. Cardiol Young 2003; 13: 240–247.CrossRefGoogle ScholarPubMed
Orwat, S, Diller, GP, Kempny, A, et al. Myocardial deformation parameters predict outcome in patients with repaired tetralogy of Fallot. Heart 2016; 102: 209–215.CrossRefGoogle ScholarPubMed
Handler, SS, Ginde, S, Bergstrom, CP, et al. Tetralogy of fallot with and without pulmonary atresia. In: Ungerleider RM, Meliones JN, McMillan KN, Cooper DS, Jacobs JP (eds.) Critical Heart Disease in Infants and Children. Elsevier, Philadelphia, 2018: 705–719.e4.Google Scholar
Wagdy, R The role of diagnostic cardiac catheterization for children with congenital heart diseases: local experience. Arch Med Sci – Atheroscler Dis 2018; 3: 72–79.CrossRefGoogle ScholarPubMed
Pushparajah, K, Duong, P, Mathur, S, et al. Cardiovascular MRI and CT in congenital heart disease. Echo Res Pract 2019; 6: R121–R138.CrossRefGoogle Scholar
Bacha, E. Valve-sparing options in tetralogy of Fallot surgery. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2012; 15: 24–26.CrossRefGoogle ScholarPubMed
Apostolopoulou, SC, Manginas, A, Kelekis, NL, et al. Cardiovascular imaging approach in pre and postoperative tetralogy of Fallot 11 Medical and Health Sciences 1103 clinical sciences. BMC Cardiovasc Disord 2019. https://doi.org/10.1186/s12872-018-0996-9 Google Scholar
Glatz, AC. Right ventricular outflow tract stenting. Circ Cardiovasc Interv 2016. https://doi.org/10.1161/CIRCINTERVENTIONS.116.004721 CrossRefGoogle ScholarPubMed
Muralidhar, K. Invited commentary: modified Blalock taussig shunt: comparison between neonates, infants and older children. Ann Card Anaesth 2014; 17: 197–199.Google Scholar
Alwi, M. Stenting the ductus arteriosus: case selection, technique and possible complications. Ann Pediatr Cardiol 2008; 1: 38.CrossRefGoogle ScholarPubMed
Kumar, R, Remadevi, K, Vaidyanathan, B, et al. Balloon pulmonary valvotomy as interim palliation for symptomatic young infants with tetralogy of Fallot. Ann Pediatr Cardiol 2008; 1: 2.CrossRefGoogle Scholar
Dohlen, G, Chaturvedi, RR, Benson, LN, et al. Stenting of the right ventricular outflow tract in the symptomatic infant with tetralogy of Fallot. Heart 2009; 95: 142–147.CrossRefGoogle ScholarPubMed
Seddio, F, Migliazza, L, Borghi, A, et al. Previous palliation in patients with tetralogy of Fallot does not influence the outcome of later repair. J Cardiovasc Med 2007; 8: 119–122.CrossRefGoogle Scholar
Fraser, CD, McKenzie, ED, Cooley, DA. Tetralogy of Fallot: surgical management individualized to the patient. Ann Thorac Surg 2001; 71: 1556–1563.CrossRefGoogle ScholarPubMed
Barron, DJ, Ramchandani, B, Murala, J, et al. Surgery following primary right ventricular outflow tract stenting for Fallot’s Tetralogy and variants: rehabilitation of small pulmonary arteries. Eur J Cardiothoracic Surg 2013; 44: 656–662.CrossRefGoogle ScholarPubMed
McGovern, E, Morgan, CT, Oslizlok, P, et al. Transcatheter stenting of the right ventricular outflow tract augments pulmonary arterial growth in symptomatic infants with right ventricular outflow tract obstruction. Cardiol Young 2016; 26: 1260–1265.CrossRefGoogle ScholarPubMed
Sandoval, JP, Chaturvedi, RR, Benson, L, et al. Right ventricular outflow tract stenting in tetralogy of fallot infants with risk factors for early primary repair. Circ Cardiovasc Interv 2016. https://doi.org/10.1161/CIRCINTERVENTIONS.116.003979 CrossRefGoogle ScholarPubMed
Quandt, D, Ramchandani, B, Stickley, J, et al. Stenting of the right ventricular outflow tract promotes better pulmonary arterial growth compared with modified Blalock-Taussig shunt palliation in tetralogy of Fallot–type lesions. JACC Cardiovasc Interv 2017; 10: 1774–1784.CrossRefGoogle ScholarPubMed
Ross, ET, Costello, JM, Backer, CL, et al. Right ventricular outflow tract growth in infants with palliated tetralogy of fallot. Ann Thorac Surg 2015; 99: 1367–1372.CrossRefGoogle ScholarPubMed
Gladman, G, McCrindle, BW, Williams, WG, et al. The modified Blalock-Taussig shunt: clinical impact and morbidity in Fallot’s tetralogy in the current era. J Thorac Cardiovasc Surg 1997; 114: 25–30.CrossRefGoogle ScholarPubMed
Ghaderian, M, Ahmadi, A, Sabri, MR, et al. Clinical outcome of right ventricular outflow tract stenting versus Blalock Taussig shunt in tetralogy of Fallot: a systematic review and meta analysis. Curr Probl Cardiol 2020; 46: 100643.CrossRefGoogle ScholarPubMed
Kanter, KR, Kogon, BE, Kirshbom, PM, et al. Symptomatic neonatal tetralogy of Fallot: repair or shunt? Ann Thorac Surg 2010; 89: 858–863.CrossRefGoogle ScholarPubMed
Alsagheir, A, Koziarz, A, Makhdoum, A, et al. Duct stenting versus modified Blalock–Taussig shunt in neonates and infants with duct-dependent pulmonary blood flow: a systematic review and meta-analysis. J Thorac Cardiovasc Surg 2020. https://doi.org/10.1016/j.jtcvs.2020.06.008 Google ScholarPubMed
Kim, G, Ban, GH, Lee, HD, et al. Effects of Balloon pulmonary valvuloplasty as preoperative palliation for tetralogy of Fallot. Congenital Heart Dis 2016; 11: 315–322.CrossRefGoogle ScholarPubMed
Wu, ET, Wang, JK, Lee, WL, et al. Balloon valvuloplasty as an initial palliation in the treatment of newborns and young infants with severely symptomatic tetralogy of Fallot. Cardiology 2005; 105: 52–56.CrossRefGoogle Scholar
Muneuchi, J, Watanabe, M, Sugitani, Y, et al. Early palliative balloon pulmonary valvuloplasty in neonates and young infants with tetralogy of Fallot. Heart Vessels 2020; 35: 252–258.CrossRefGoogle Scholar
Ducas, RA, Harris, L, Labos, C, et al. Outcomes in young adults with tetralogy of Fallot and pulmonary annular preserving or transannular patch repairs. Can J Cardiol 2020. https://doi.org/10.1016/j.cjca.2020.04.014 Google ScholarPubMed
Luijten, LWG, Van den Bosch, E, Duppen, N, et al. Long-term outcomes of transatrial-transpulmonary repair of tetralogy of Fallot. Eur J Cardio-Thoracic Surg 2015. https://doi.org/10.1093/ejcts/ezu182 CrossRefGoogle ScholarPubMed
Padalino, MA, Vida, VL, Stellin, G. Transatrial-transpulmonary repair of tetralogy of Fallot. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2009. https://doi.org/10.1053/j.pcsu.2009.01.005 CrossRefGoogle ScholarPubMed
Karl, T. Tetralogy of Fallot: current surgical perspective. Ann Pediatr Cardiol 2008. https://doi.org/10.4103/0974-2069.43873 CrossRefGoogle ScholarPubMed
Spinale, FG. Assessment of cardiac function-Basic principles and approaches. Compr Physiol 2015. https://doi.org/10.1002/cphy.c140054 CrossRefGoogle Scholar
Menaissy, Y, Omar, I, Mofreh, B, et al. Total correction of tetralogy of Fallot in the first 60 days of life in symptomatic infants: is it the gold standard? Thorac Cardiovasc Surg 2020. https://doi.org/10.1055/s-0039-1678698 Google ScholarPubMed
Steiner, MB, Tang, X, Gossett, JM, et al. Timing of complete repair of non-ductal-dependent tetralogy of Fallot and short-term postoperative outcomes, a multicenter analysis. J Thorac Cardiovasc Surg 2014. https://doi.org/10.1016/j.jtcvs.2013.06.019 CrossRefGoogle ScholarPubMed
Loomba, RS, Buelow, MW, Woods, RK. Complete repair of tetralogy of Fallot in the neonatal versus non-neonatal period: a meta-analysis. Pediatr Cardiol 2017; 38: 893–901.CrossRefGoogle ScholarPubMed
Sharkey, AM, Sharma, A. Tetralogy of Fallot: Anatomic variants and their impact on surgical management. Semin Cardiothorac Vasc Anesth 2012. https://doi.org/10.1177/1089253211434566 CrossRefGoogle ScholarPubMed
Jeon, B, Kim, DH, Kwon, BS, et al. Surgical treatment of tetralogy of Fallot in symptomatic neonates and young infants. J Thorac Cardiovasc Surg 2020. https://doi.org/10.1016/j.jtcvs.2019.10.172 CrossRefGoogle ScholarPubMed
Yun, TJ. Valve-sparing repair to alleviate pulmonary regurgitation may lead to as much right ventricular dilatation as a transannular patch: a catch-22? J Thorac Cardiovasc Surg 2018. https://doi.org/10.1016/j.jtcvs.2017.09.116 CrossRefGoogle Scholar
Khan, SM, Drury, NE, Stickley, J, et al. Tetralogy of Fallot: morphological variations and implications for surgical repair. Eur J Cardio-thoracic Surg 2019. https://doi.org/10.1093/ejcts/ezy474 CrossRefGoogle ScholarPubMed
van der Ven, JPG, van den Bosch, E, Bogers, AJCC, et al. Current outcomes and treatment of tetralogy of Fallot. F1000Research. 2019. https://doi.org/10.12688/f1000research.17174.1 CrossRefGoogle ScholarPubMed
Vida, VL, Angelini, A, Guariento, A, et al. Preserving the pulmonary valve during early repair of tetralogy of Fallot: anatomic substrates and surgical strategies. J Thorac Cardiovasc Surg 2015. https://doi.org/10.1016/j.jtcvs.2015.01.030 CrossRefGoogle ScholarPubMed
Weinberg, CR, McElhinney, DB. Pulmonary valve replacement in tetralogy of Fallot. Circulation 2014; 130: 995–998.CrossRefGoogle ScholarPubMed
Cocomello, L, Meloni, M, Rapetto, F, et al. Long-term comparison between pulmonary homograft versus bioprosthesis for pulmonary valve replacement in tetralogy of Fallot. J Am Heart Assoc 2019. https://doi.org/10.1161/JAHA.119.013654 CrossRefGoogle ScholarPubMed
Mongeon, FP, Ben Ali, W, Khairy, P, et al. Pulmonary valve replacement for pulmonary regurgitation in adults with tretralogy of fallot: a meta-analysis-a report for the writing committee of the 2019 update of the Canadian Cardiovascular Society Guidelines for the Management of Adults with congenital heart disease. Can J Cardiol 2019; 35: 1772–1783.CrossRefGoogle Scholar
Bokma, JP, Geva, T, Sleeper, LA, et al. A propensity score-adjusted analysis of clinical outcomes after pulmonary valve replacement in tetralogy of Fallot. Heart 2018; 104: 738–744.CrossRefGoogle ScholarPubMed
Bailey, J, Elci, OU, Mascio, CE, et al. Staged versus complete repair in the symptomatic neonate with tetralogy of Fallot. Ann Thorac Surg 2020. https://doi.org/10.1016/j.athoracsur.2019.10.013 CrossRefGoogle ScholarPubMed
Yang, S, Wen, L, Tao, S, et al. Impact of timing on in-patient outcomes of complete repair of tetralogy of Fallot in infancy: an analysis of the United States National Inpatient 2005–2011 database. BMC Cardiovasc Disord 2019. https://doi.org/10.1186/s12872-019-0999-1 CrossRefGoogle ScholarPubMed
Savla, JJ, Faerber, JA, Huang, YS V., et al. 2-Year outcomes after complete or staged procedure for tetralogy of Fallot in neonates. J Am Coll Cardiol 2019. https://doi.org/10.1016/j.jacc.2019.05.057 CrossRefGoogle ScholarPubMed
Townsley, MM, Windsor, J, Briston, D, et al. Tetralogy of Fallot: perioperative management and analysis of outcomes. J Cardiothorac Vasc Anesth 2019; 33: 556–565.CrossRefGoogle ScholarPubMed
Mouws, EMJP, de Groot, NMS, van de Woestijne, PC, et al. Tetralogy of Fallot in the current era. Semin Thorac Cardiovasc Surg 2019. https://doi.org/10.1053/j.semtcvs.2018.10.015 CrossRefGoogle ScholarPubMed
Norgård, G, Gatzoulis, MA, Moraes, F, et al. Relationship between type of outflow tract repair and postoperative right ventricular diastolic physiology in tetralogy of Fallot implications for long-term outcome. Circulation 1996; 94: 3276–3280.CrossRefGoogle ScholarPubMed
Chandler, HK, Kirsch, R. Management of the low cardiac output syndrome following surgery for congenital heart disease. Curr Cardiol Rev 2016; 12: 107–111.CrossRefGoogle ScholarPubMed
Smith, CA, McCracken, C, Thomas, AS, et al. Long-term outcomes of tetralogy of Fallot: a study from the pediatric cardiac care consortium. JAMA Cardiol 2019. https://doi.org/10.1001/jamacardio.2018.4255 CrossRefGoogle ScholarPubMed
Hoashi, T, Kagisaki, K, Meng, Y, et al. Long-term outcomes after definitive repair for tetralogy of Fallot with preservation of the pulmonary valve annulus. J Thorac Cardiovasc Surg 2014; 148: 802–809.CrossRefGoogle ScholarPubMed
Kim, H, Sung, SC, Kim, SH, et al. Early and late outcomes of total repair of tetralogy of Fallot: risk factors for late right ventricular dilatation. Interact Cardiovasc Thorac Surg 2013; 17: 956–962.CrossRefGoogle ScholarPubMed
Hickey, EJ, Veldtman, G, Bradley, TJ, et al. Late risk of outcomes for adults with repaired tetralogy of Fallot from an inception cohort spanning four decades. Eur J Cardiothoracic Surg 2009; 35: 156–164.CrossRefGoogle ScholarPubMed
Wald, RM, Marie Valente, A, Marelli, A. Heart failure in adult congenital heart disease: emerging concepts with a focus on tetralogy of Fallot. Trends Cardiovasc Med 2015; 25: 422–432.CrossRefGoogle ScholarPubMed
Loke, YH, Harahsheh, AS, Krieger, A, et al. Usage of 3D models of tetralogy of Fallot for medical education: impact on learning congenital heart disease. BMC Med Educ 2017. https://doi.org/10.1186/s12909-017-0889-0 CrossRefGoogle ScholarPubMed
Moorjani, N, Lewis, M, Shah, R, et al. Implementation of a novel portfolio of structured, curriculum-aligned, simulation-based, cardiothoracic surgery training courses: evolving the delivery of surgical education. J Thorac Cardiovasc Surg 2017. https://doi.org/10.1016/j.jtcvs.2017.07.075 CrossRefGoogle ScholarPubMed
Miller, DL, Lu, X, Dou, C, et al. Ultrasonic cavitation-enabled treatment for therapy of hypertrophic cardiomyopathy: proof of principle. Ultrasound Med Biol 2018; 44: 1439–1450.CrossRefGoogle ScholarPubMed
Borhani, S, Hassanajili, S, Ahmadi Tafti, SH, et al. Cardiovascular stents: overview, evolution, and next generation. Prog Biomater 2018; 7: 175–205.CrossRefGoogle ScholarPubMed
Barron, DJ, Vanderlaan, RD. Predicting the future: tetralogy of Fallot will be primarily treated with catheter based intervention within two decades. surgeon’s perspective. Pediatr Cardiol 2020; 41: 546–552.CrossRefGoogle Scholar
Lurz, P, Coats, L, Khambadkone, S, et al. Percutaneous pulmonary valve implantation: impact of evolving technology and learning curve on clinical outcome. Circulation 2008; 117: 1964–1972.CrossRefGoogle ScholarPubMed