ABSTRACT
Monocusp valves are thought to reduce early operative mortality and morbidity associated with pediatric tetralogy of Fallot repair. As there are no published randomized clinical trials comparing outcomes with and without a monocusp valve, we performed a meta-analysis of observational studies in accordance with established protocols. After systematically searching PubMed, the Cochrane Library, and Google Scholar, 12 studies were included. The operative mortality was compared in 695 patients, and we found no difference between patients with and patients without a monocusp valve. Monocusp valves may not improve operative mortality of tetralogy of Fallot repair in pediatric patients.
Subject(s)
Cardiac Surgical Procedures/methods , Plastic Surgery Procedures/methods , Pulmonary Valve/surgery , Tetralogy of Fallot/surgery , Child , Global Health , Humans , Observational Studies as Topic , Survival Rate/trends , Tetralogy of Fallot/mortality , Treatment OutcomeABSTRACT
OBJECTIVES: Transannular patching is used to relieve significant pulmonary annular stenosis during tetralogy of Fallot repair. Although recent literature has focused on the deleterious effects of pulmonary regurgitation, inadequate relief of stenosis may increase postoperative mortality and the re-intervention rate. Patching criteria based on pulmonary annular z-scores are ambiguous because of the use of varied z-score data sets. This study aimed to generate data that could be used to optimize z-score use for patch insertion. METHODS: A retrospective review was made of medical records of patients who had a valve-sparing repair of tetralogy of Fallot between 1 January 2000 and 31 December 2010. In a selected group in which the residual gradient was confined to the pulmonary valve, the post-repair peak pressure gradient was determined by trans-thoracic echocardiography and was correlated with the intra-operative pulmonary valve annulus (PVA) diameter z-score. Regression analysis was used to examine this relationship. RESULTS: Data from 46 patients with valve-sparing repair were reviewed; the median age and median weight were 6.5 months and 6.6 kg, respectively; the 30-day mortality was 2.2%. Analysis of these data implies that 25% of the time, all patients with a PVA z-score of -1.3 would have a PVA gradient ≥30 mmHg. CONCLUSIONS: Criteria that recommend a transannular patch insertion only when the PVA diameter z-score is significantly smaller than -1.3 (e.g. -3) may result in a significant number of patients with an unacceptable post-repair PVA gradient.
Subject(s)
Cardiac Surgical Procedures/instrumentation , Cardiac Surgical Procedures/methods , Pulmonary Valve/surgery , Tetralogy of Fallot/surgery , Child , Child, Preschool , Humans , Infant , Pressure , Pulmonary Valve Stenosis/surgery , Regression Analysis , Retrospective StudiesABSTRACT
Cardiac structure size influences surgical decision making in pediatric cardiac surgery. Lack of universally adopted normative cardiac structure dimensions may confound decision making. A review of the relevant literature contained in 2 large databases was performed with a view to determine the optimal normative cardiac structure dimensions for clinical use. The current article initially discusses technical issues related to cardiac structure measurement and measurement normalization. It then describes the literature search strategy and examines the quality of published data in subjects below 19 years of age. The optimal normative dimension data set is then recommended.
