Abstract 15372: The Right Ventricular Infundibular Sparing Approach for the Repair of Tetralogy of Fallot Results in Better Intermediate-Term Right Ventricular and Left Ventricular Systolic Function as Assessed by Cardiac MRI
Introduction: The right ventricular infundibular sparing approach (RVIS) to repair Tetralogy of Fallot (TOF) avoids the ventricular incision used in the transventricular (TV) approach.
Hypothesis: We hypothesize that patients repaired with the RVIS approach have less right ventricular dilation and better RV systolic function assessed by cardiac MRI (CMR) than patients who had a TV repair.
Methods: This is a retrospective cohort study of patients who underwent RVIS repair of TOF at one institution or TV repair at a seperate institution and were later evaluated by CMR. Patients were placed into 1 of 4 age-matched groups. We compared right ventricular end diastolic and systolic volumes indexed to body surface area (RVEDVi and RVESVi) and right ventricular ejection fraction (RVEF) as primary endpoints. Secondary endpoints included pulmonary regurgitant fraction (PRF), left ventricular end diastolic volume indexed to body surface area (LVEDVi), and left ventricular ejection fraction (LVEF). Chi-Square, Student’s t, and Mann-Whitney tests were used as appropriate.
Results: Ninety patients were included in the analysis; 45 underwent RVIS repair at median age of 9.8 months (IQR: 6.3-14.6) and 45 underwent TV repair at median age of 4.0 months (IQR: 2.8-6.3), (p<0.01). Heterogeneity existed in the methods used to relieve RV outflow tract obstruction, as efforts were made to spare the pulmonary valve in both groups. None of the patients in the TV group had an initial palliation with a systemic to pulmonary arterial shunt compared to 16 (36%) in the RVIS group (p<0.01). The median age at MRI was 9.3 years (IQR: 6.3-14.1) in the RVIS group and 9.0 years (IQR: 5.8-12.7) in the TV repair group (p=0.3). There were no differences in RVEDVi (122±25 cc/m2 vs 119±32 cc/m2, p= 0.59) or PRF (40±13 vs 37±18, p=0.29) between the RVIS and TV repair groups. Compared to the TV repair group, the RVIS group had higher RVEF (54±6 vs 44±9, p<0.01), lower RVESVi (57±17 cc/m2 vs 67±25 cc/m2, p=0.03), and higher LVEF (61±11 vs 54±8, p<0.01).
Conclusions: Patients who underwent RVIS repair for TOF appeared to have better right and left ventricular systolic function compared to those who had a TV repair. These observations have important implications for prognosis and merit further study.
Author Disclosures: M.K. Olive: None. S. Kutty: None. C.D. Fraser: None. E.D. McKenzie: None. J.M. Hammel: None. R. Krishnamurthy: None. S.A. Maskatia: None.
- © 2014 by American Heart Association, Inc.