On Indications Of Repair Of Tetralogy Of Fallot Via Transatrial/Transpulmonary Approach

Object:Retrospectively study the data of our patients with Tetralogy of Fallot from different surgical approaches;discuss the indications of the radical operation of tetralogy of Fallot from transatrial/transpulmonary approach; provide proofs for clinical selection of surgical approaches.Patients and Methods:140 consecutive patients with tetralogy of Fallot underwent primary repair between January 2007 and May 2010 in the second hospital of XiangYa. Diagnosis were made by two-dimensional echocardiogram and CT angiography preoperative. Patients with double outlet of right ventricle, TOF with pulmonary atresia, or with prior palliative surgery were excluded.A transatrial(RA) approach was used in 40 patients, a transatrial-transpulmonary(RA-PA) approach was uesd in 37 patients, and a transventricular(RA-PA-RV) approach in 63 patients.There was no statistical significance in gender, age, weight, body surface area, oxygen saturation, hemoglobin concentration, hematocrit and functional parameter of heart in each group, but there was a high ratio in RA-PA-RV group of bivalve pulmonary, subarterial ventricular septal defect, and aorta overriding exceeding fifty percent. All the situations have been recorded such as the pulmonary annulus Z-score and McGoon value,evaluate developmental condition of pulmonary artery, heart function preoperative, and observe cardiopulmonary bypass condition. At the end of the procedure,pressures in the right and left ventricles were measured and recorded.SPSS 16.0 was employed to analyze the statistic like a retrospective study of early mortality and complications, postoperative data including mechanical ventilation time, ICU stay time, and hospital day, and echocardiographic follow-up data.Results:In extracorporeal circulation, it can be seen clearly that the RA group used much less time than the RA-PA group or the RA-PA-RV group (P< 0.05),and the RA-PA group much faster than the RA-PA-RV group (P<0.05);about the aorta clamping, the RA group used much less time than the RA-PA-RV group or the RA-PA-RV group (P<0.05),and RA-PA less than the RA-PA-RV group.However, there is no statistical difference (P>0.05).With the examination of the preoperative echocardiogram, the size of the pulmonary annular in RA group is bigger than that of the RA-PA group, the size in RA-PA group is bigger than that in RA-PA-RV group,with no statistical differences (P>0.05),and the RA group bigger than the RA-PA-RV, with statistical differences(P<0,05). The size of the main pulmonary artery and left pulmonary artery in the RA group is much bigger than that in the RA-PA group and RA-PA-RV group (P<0.05),the RA-PA group bigger than RA-PA-RV group with no statistical differences (P>0.05),and there is also no significance with the size of the right pulmonary in different groups.The pulmonary annular Z-score in the RA group is higher than RA-PA group,and RA-PA group higher than RA-PA-RV group with some statistic significance (P<0.05). Among the preoperative CTA examinations, the McGoon value in RA group is greater than RA-PA group with no statistic difference; RA group greater than RA-PA-RV group and RA-PA group greater than RA-PA-RV group with some differences (P>0.05).There is no statistic difference among all the groups of heart funcation. (P>0.05). As for the postoperative-hospital day, the duration of ventilation and the ICU stay time, patients in RA group spent much less time than those in RA-PA group, and RA-PA group less than RA-PA-RV group with no statistic differences (P>0.05);RA group less than RA-PA-RV group with differences(P<0.05).Results of echocardiogram compared with the results after operation, PG in every group has gone down obviously with differences (P<0.05);the size of the main pulmonary artery goes up greatly (P<0.05);EDV in every group also goes up significantly with some differences (P<0.05).There are 5 peroperative deaths, and the general mortality arrives at 3.57%.LOS happened much more often than any others. During the follow-up within 1-41 months, there is no death, and no life-threatening arrhythmia, and no reoperation. The New York Association functional class of all the patients go betweenⅠ～Ⅱlevel,and with the echocardiogram, the pressure gradient has gone down to varied degree.Conclusion:Tetralogy of Fallot can be completely repaired via transatrial/transpulmonary approach successfully, do not increase the mortality and complications, especiall when pulmonary annular Z-score greater than-3.