Abstract 20276: Tetralogy of Fallot With Hypoplastic Branch Pulmonary Arteries: Aggressive Patch Augmentation Improves Short-Term Geometry but Increases Risk of Late Re-Interventions
Introduction: When encountering hypoplastic branch pulmonary arteries (PA) during tetralogy of Fallot repair (TOF), strategies include: 1) patch augment to hilum (PATCH), 2) extending patches into proximal part only (EXTEND), or 3) leave native vessels uninstrumented in anticipation of growth (NATIVE). We tested outcomes for these opposing strategies.
Methods: We studied all 434 TOF repairs (2000-12, excluding pulmonary atresia). Risk-adjusted models analyzed competing endstates of branch PA reintervention or death. PA growth was explored via repeated measures analysis of 2123 echo measurements. Subgroup analysis of children with branch PA < 4 mm at time of repair was performed.
Results: Overall survival was excellent (99%; 3 deaths). Mean freedom from catheter or surgical re-intervention to branch PAs at 10 years was 84%. In models risk-adjusted for baseline features (including PA size), PATCH augmentation of branch PAs was associated with significantly higher rates of re-intervention (75% freedom; p<.01) versus EXTEND (82%) or NATIVE (86%). Additional risk factors included small indexed branch PAs and transcatheter interventions prior to index TOF repair. Additionally, time-related branch PA growth following full PATCH was significantly less than other children (N=2123 echos; p<.01).
Branch PA < 4mm:
In PATCH(28), EXTEND(60) and REPAIR(75) groups, freedom from re-intervention adjusted for BPA z-score was 60%, 70% and 80% respectively, and patient characteristics were similar (figure). More PATCH children had received PA stents (P=.04), but the majority of all groups had not (figure). Aggressive PATCH strategy was associated with decreased time-related branch PA growth (p=.02, 667 echos).
Conclusions: Aggressive patch augmentation of branch PAs improves short-term geometry but may lead to late stenosis and higher rates of re-intervention. Hypoplastic branch PAs in TOF tend to grow well in their native state or with minimal surgical manipulation.
Author Disclosures: T.J. Wilder: None. G. Van Arsdell: None. E. Pham-Hung: None. M. Gritti: None. S. Hussain: None. C.A. Caldarone: None. A. Redington: None. E.J. Hickey: None.
- © 2014 by American Heart Association, Inc.