Proportion Of Pulmonary Valve Annulus: A New Predictive Index For Transannular Patch In Repair Of Tetralogy Of Fallot

Objective In Tetralogy of Fallot,whether relieving right ventricular outflow tract obstruction requires transannular patch(TAP)of the pulmonary valve depends on pulmonary valvular annulus size.The z-score of pulmonary valvular annulus is most commonly used as a predictive index.However,z value is affected by many factors,such as height,weight,body surface area and reference population.The calculation method is complex and the clinical application is limited.of pulmonary valvular annulus,that is,the proportion of pulmonary valvular annulus size to total size of aortic valvular annulus and pulmonary valvular annulus,can provide scientific guidance for operation.Method A retrospective analysis of patients who underwent total correction of tetralogy of Fallot between January 2016 to January 2018.The patients was categorized into two groups,TAP versus non-TAP.The sizes of pulmonary and aortic valvular annulus were evaluated in each group,and the proportion of pulmonary valvular annulus cutoff values for TAP were calculated.Result A total of 254 patients were enrolled in the study according to inclusion criteria and exclusion criteria.Of these,164(64.6%)underwent transannular patch repair and 90(35.4%)underwent non-transannular patch repair.Both proportion of pulmonary valvular annulus and z-scores were smaller in the TAP group than in the non-TAP group(0.29±0.06 VS 0.36±0.06,p<0.0001;-4.05±2.13 VS-2.06±1.84,p<0.0001,respectively).In receiver operating characteristics analyses,proportion of pulmonary valvular annulus and the z-score cutoff values were 0.353(area under the curve0.781;95%CI:0.725~0.831)and-2.13(area under the curve 0.766;95%CI:0.709~0.817),respectively,demonstrating that the proportion of pulmonary valvular annulus was a more powerful diagnostic tool as a predictor of TAP.Conclusion Our results suggest that the proportion of pulmonary valvular annulus is a effective predictor for TAP and can be easily applied to clinical practice.