Monocusp Valves Do Not Improve Early Operative Mortality in Tetralogy of Fallot: A Meta-Analysis.

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.

Optimal Use of Z-Scores to Preserve the Pulmonary Valve Annulus During Repair of Tetralogy of Fallot.

OBJECTIVE: The size of the pulmonary annulus measured as a z-score is often used to determine when to insert a transannular patch (TAP). Multiple "cutoffs" are quoted in the literature; this could lead to inappropriate insertion. We aimed to determine whether the use of z-scores derived from different populations may have contributed to the varied "cutoffs" quoted. METHODS: PubMed was searched using the terms: "tetralogy," "Fallot," "transannular," "patch," "mortality," and "death." Studies published between January 1, 2005, and October 5, 2017, were included; studies without participants under the age of 18 years and studies that did not describe the operative procedure were excluded. RESULTS: Of 52 papers retrieved, 19 were included representing 2,500 repaired patients; 1,371 (54.8%) had a TAP. Five (26.3%) papers representing 638 patients (25.5%) quoted a z-score "cutoff" and what data set was used; "cutoffs" ranged from -2 to -4 and were derived from 2 different data sets. Three studies quoted a data set that has been shown in previous work to be problematic; the only quoted "cutoffs" of -4 were from two of these studies. CONCLUSIONS: Surprisingly few (26.3%) studies mention what pulmonary annulus size "cutoff" was used to decide when to insert a TAP. Z-scores derived from different populations were used by different studies and it is possible that this may have contributed to the varied "cutoffs' quoted. Recommendations to perform valve-sparing surgery in pulmonary annuli as small as -4 may not be warranted. Future papers should record "cutoffs" employing recommended z-score data set.

Optimal Z-Score Use in Surgical Decision-Making in Pulmonary Atresia With Intact Ventricular Septum.

OBJECTIVES: In the surgical treatment of pulmonary atresia with intact ventricular septum, the size of the tricuspid valve annulus (as measured by z-scores) has emerged as a significant factor in deciding which repair to perform. Various tricuspid valve annulus z-scores are reported as "cutoffs" for successful biventricular repair. We aimed to determine whether the use of different z-score data sets contributed to the gross variation in "cutoffs" for successful biventricular repair reported in the literature. METHODS: A single search was made of PubMed using the "advanced" setting with the following search terms: pulmonary, atresia, intact, septum, z, and score. The filters "title" and "title/abstract" were used for the first four and last two terms, respectively; the instruction "AND" combined all terms. Articles that identified which z-score data set was used in patients with biventricular repairs were included. RESULTS: From 13 articles, 1,392 patients were studied, 410 (29.5%) of which achieved biventricular repair. Three z-score data sets were quoted; mean tricuspid valve annulus z-scores in biventricular repair patients ranged between -0.53 and -5.1. After correcting for discrepancies between z-score data sets, no study reported a mean tricuspid valve annulus z-score <-2.8 in biventricular repair patients and 83.3% reported mean tricuspid valve annuli z-scores >-1.7. CONCLUSION: The use of varied tricuspid valve annuli z-score data sets may have contributed to gross variations in reported "cutoffs" for successful biventricular repair. This could lead to inappropriate surgical pathway allocation.