Comparison of Short-term Outcomes of Radical Correction of Tetralogy of Fallot with or without Transcatheter Embolization of Major Aortopulmonary Collaterals_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

 LIUChao , GUOPeng-ju , WENBing , XUHua-shan , ZHAOWen-zeng

Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052, P. R. China;

Corresponding author：

LIUChao, Email: liubeilun@sohu.com

Keywords：

Tetralogy of Fallot; Aortopulmonary collateral; Radical correction; Embolization; Therapeutic effect

DOI：

10.7507/1007-4848.20140179

Video：

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Objective To compare short-term outcomes of radical correction of tetralogy of Fallot (TOF)with or without transcatheter embolization of major aortopulmonary collaterals (APC). Methods Clinical data of 58 TOF patients undergoing radical correction from January 2008 to June 2013 in the Department of Cardiovascular Surgery, First Affiliated Hospital of Zhengzhou University were retrospectively analyzed. There were 36 male and 22 female patients. Among them, 22 patients (Group A, 12 males and 10 females)received radical TOF correction combined with transcatheter embolization of major APC, and 36 patients (Group B, 24 males and 12 females)received radical TOF correction alone. Average age of group A was (24.91±6.77)years and that of group B was (22.42±5.06)years. Aortic cross-clamping time, ICU stay, postoperative hospital stay, left ventricular ejection fraction (LVEF)7 days and 3 months after the operation were compared between the 2 groups. Results There was no in-hospital death. There was no statistical difference in sex, age, preoperative McGoon ratio or hemoglobin (Hb)levels between the 2 groups (P > 0.05). Aortic cross-clamping time[ (43.87±13.02)minutes vs. (53.60±11.69)minutes, P < 0.05], ICU stay[ (26.09±4.84)hours vs. (28.87±4.38)hours, P < 0.05] and postoperative hospital stay[ (12.32±1.81)days vs. (13.67±2.14)days, P < 0.05] of group A were significantly shorter than those of group B. LVEF 7 days after the operation of group A was significantly higher than that of group B (56.64%±8.19% vs. 52.58%±5.62%, P < 0.05), and there was no statistical difference in LVEF 3 months after the operation between the 2 groups (58.50%±8.78% vs. 55.42%±6.18%, P > 0.05). Conclusion For surgical treatment of TOF, compared with radical correction alone, radical correction combined with transcatheter embolization of major APC can significantly shorten aortic cross-clamping time and improve postoperative heart function recovery.

Citation： LIUChao, GUOPeng-ju, WENBing, XUHua-shan, ZHAOWen-zeng. Comparison of Short-term Outcomes of Radical Correction of Tetralogy of Fallot with or without Transcatheter Embolization of Major Aortopulmonary Collaterals. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2014, 21(5): 632-635. doi: 10.7507/1007-4848.20140179 Copy

1.	Apitz C, Webb GD, Redington AN. Tetralogy of Fallot. Lancet, 2009, 374(9699):1462-1471.
2.	Arenz C, Laumeier A, Lütter S, et al. Is there any need for a shunt in the treatment of tetralogy of Fallot with one source of pulmonary blood flow? Eur J Cardiothorac Surg, 2013, 44(4):648-654.
3.	刘迎龙, 沈向东, 李守军等.介入及手术联合矫治伴有体肺动脉侧枝的肺血减少型先天性心脏病.中华医学杂志, 2006, 86(4):228-231.
4.	Ong K, Boone R, Gao M, et al. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111(11):1638-1643.
5.	胡盛寿, 李守军, 张浩等.介入技术和外科手术同期"复合"治疗先天性心脏病的临床研究.中华心血管病杂志, 2006, 34(3):236-239.
6.	郑哲, 李守军, 胡盛寿等.分期和"一站式"Hybrid手术治疗法洛四联症合并体肺动脉侧枝血管形成的疗效比较.中国胸心血管外科临床杂志, 2009, 16(4):250-253.
7.	刘浪, 陈凯明, 赖锋华, 等.杂交技术在法洛四联症治疗中的应用.中国胸心血管外科临床杂志, 2013, 20(1):108-110.
8.	Kon ZN, Brown EN, Tran R, et al. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass. J Thorac Cardiovasc Surg, 2008, 135(02):367-375.
9.	Yoo BW, Kim JO, Kim YJ, et al. Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. J Thorac Cardio-vasc Surg, 2012, 143(6):1299-1304.
10.	Schwartz MC, Rome JJ, Gillespie MJ, et al. Relation of left ventri-cular end diastolic pressure to right ventricular end diastolic volume after operative treatment of tetralogy of fallot. Am J Cardiol, 2012, 109(3):417-422.
11.	Maskatia SA, Spinner JA, Morris SA, et al. Effect of branch pulmonary artery stenosis on right ventricular volume overload in patients with tetralogy of fallot after initial surgical repair. Am J Cardiol, 2013, 111(9):1355-1360.
12.	Grosse-Wortmann L, Yoo SJ, van Arsdell G, et al. Preoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg, 2013, 146(5):1185-1190.
13.	Broberg CS, Aboulhosn J, Mongeon FP, et al. Prevalence of left ventricular systolic dysfunction in adults with repaired tetralogy of fallot. Am J Cardiol, 2011, 107(8):1215-1220.
14.	Uebing A, Gibson DG, Babu-Narayan SV, et al. Right ventricular mechanics and QRS duration in patients with repaired tetralogy of Fallot:implications of infundibular disease. Circulation, 2007, 116(14):1532-1539.
15.	Diller GP, Kempny A, Liodakis E, et al. Left ventricular longitudinal function predicts life-threatening ventricular arrhythmia and death in adults with repaired tetralogy of fallot. Circulation, 2012, 125(20):2440-2446.
16.	Kempny A, Diller GP, Orwat S, et al. Right ventricular-left ventricular interaction in adults with Tetralogy of Fallot:a combined cardiac magnetic resonance and echocardiographic speckle tracking study. Int J Cardiol, 2012, 154(3):259-264.
17.	Fernandes FP, Manlhiot C, Roche SL, et al. Impaired left ventricular myocardial mechanics and their relation to pulmonary regurgitation, right ventricular enlargement and exercise capacity in asymptomatic children after repair of tetralogy of Fallot. J Am Soc Echocardiogr, 2012, 25(5):494-503.
18.	Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot:a multicentre study. Lancet, 2000, 356(9234):975-981.
19.	Khairy P, Harris L, Landzberg MJ, et al. Implantable cardioverter-defibrillators in Tetralogy of Fallot. Circulation, 2008, 117(3):363-370.
20.	Asija R, Hanley FL, Roth SJ. Postoperative respiratory failure in children with tetralogy of fallot, pulmonary atresia, and major aorto-pulmonary collaterals:a pilot study. Pediatr Crit Care Med, 2013, 14(4):384-389.
21.	范祥明, 刘迎龙, 闫军, 等.肺动脉发育不良型法洛四联症根治术前姑息手术和介入技术的应用.中华胸心血管外科杂志, 2011, 27(10):581-583.

1. Apitz C, Webb GD, Redington AN. Tetralogy of Fallot. Lancet, 2009, 374(9699):1462-1471.
2. Arenz C, Laumeier A, Lütter S, et al. Is there any need for a shunt in the treatment of tetralogy of Fallot with one source of pulmonary blood flow? Eur J Cardiothorac Surg, 2013, 44(4):648-654.
3. 刘迎龙, 沈向东, 李守军等.介入及手术联合矫治伴有体肺动脉侧枝的肺血减少型先天性心脏病.中华医学杂志, 2006, 86(4):228-231.
4. Ong K, Boone R, Gao M, et al. Right ventricle to pulmonary artery conduit reoperations in patients with tetralogy of fallot or pulmonary atresia associated with ventricular septal defect. Am J Cardiol, 2013, 111(11):1638-1643.
5. 胡盛寿, 李守军, 张浩等.介入技术和外科手术同期"复合"治疗先天性心脏病的临床研究.中华心血管病杂志, 2006, 34(3):236-239.
6. 郑哲, 李守军, 胡盛寿等.分期和"一站式"Hybrid手术治疗法洛四联症合并体肺动脉侧枝血管形成的疗效比较.中国胸心血管外科临床杂志, 2009, 16(4):250-253.
7. 刘浪, 陈凯明, 赖锋华, 等.杂交技术在法洛四联症治疗中的应用.中国胸心血管外科临床杂志, 2013, 20(1):108-110.
8. Kon ZN, Brown EN, Tran R, et al. Simultaneous hybrid coronary revascularization reduces postoperative morbidity compared with results from conventional off-pump coronary artery bypass. J Thorac Cardiovasc Surg, 2008, 135(02):367-375.
9. Yoo BW, Kim JO, Kim YJ, et al. Impact of pressure load caused by right ventricular outflow tract obstruction on right ventricular volume overload in patients with repaired tetralogy of Fallot. J Thorac Cardio-vasc Surg, 2012, 143(6):1299-1304.
10. Schwartz MC, Rome JJ, Gillespie MJ, et al. Relation of left ventri-cular end diastolic pressure to right ventricular end diastolic volume after operative treatment of tetralogy of fallot. Am J Cardiol, 2012, 109(3):417-422.
11. Maskatia SA, Spinner JA, Morris SA, et al. Effect of branch pulmonary artery stenosis on right ventricular volume overload in patients with tetralogy of fallot after initial surgical repair. Am J Cardiol, 2013, 111(9):1355-1360.
12. Grosse-Wortmann L, Yoo SJ, van Arsdell G, et al. Preoperative total pulmonary blood flow predicts right ventricular pressure in patients early after complete repair of tetralogy of Fallot and pulmonary atresia with major aortopulmonary collateral arteries. J Thorac Cardiovasc Surg, 2013, 146(5):1185-1190.
13. Broberg CS, Aboulhosn J, Mongeon FP, et al. Prevalence of left ventricular systolic dysfunction in adults with repaired tetralogy of fallot. Am J Cardiol, 2011, 107(8):1215-1220.
14. Uebing A, Gibson DG, Babu-Narayan SV, et al. Right ventricular mechanics and QRS duration in patients with repaired tetralogy of Fallot:implications of infundibular disease. Circulation, 2007, 116(14):1532-1539.
15. Diller GP, Kempny A, Liodakis E, et al. Left ventricular longitudinal function predicts life-threatening ventricular arrhythmia and death in adults with repaired tetralogy of fallot. Circulation, 2012, 125(20):2440-2446.
16. Kempny A, Diller GP, Orwat S, et al. Right ventricular-left ventricular interaction in adults with Tetralogy of Fallot:a combined cardiac magnetic resonance and echocardiographic speckle tracking study. Int J Cardiol, 2012, 154(3):259-264.
17. Fernandes FP, Manlhiot C, Roche SL, et al. Impaired left ventricular myocardial mechanics and their relation to pulmonary regurgitation, right ventricular enlargement and exercise capacity in asymptomatic children after repair of tetralogy of Fallot. J Am Soc Echocardiogr, 2012, 25(5):494-503.
18. Gatzoulis MA, Balaji S, Webber SA, et al. Risk factors for arrhythmia and sudden cardiac death late after repair of tetralogy of Fallot:a multicentre study. Lancet, 2000, 356(9234):975-981.
19. Khairy P, Harris L, Landzberg MJ, et al. Implantable cardioverter-defibrillators in Tetralogy of Fallot. Circulation, 2008, 117(3):363-370.
20. Asija R, Hanley FL, Roth SJ. Postoperative respiratory failure in children with tetralogy of fallot, pulmonary atresia, and major aorto-pulmonary collaterals:a pilot study. Pediatr Crit Care Med, 2013, 14(4):384-389.
21. 范祥明, 刘迎龙, 闫军, 等.肺动脉发育不良型法洛四联症根治术前姑息手术和介入技术的应用.中华胸心血管外科杂志, 2011, 27(10):581-583.

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Comparison of Short-term Outcomes of Radical Correction of Tetralogy of Fallot with or without Transcatheter Embolization of Major Aortopulmonary Collaterals

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