Right Ventricular Outflow Tract Reconstruction With Contegra Monocuspid Transannular Patch in Tetralogy of Fallot

Outcomes of Transannular Repair of Tetralogy of Fallot With a Contegra® Monocuspid Patch

BACKGROUND

Surgical repair of tetralogy of Fallot (ToF) depends on the anatomical variations of the heart defect. A group of patients with a hypoplastic pulmonary valve annulus required a transannular patch. This study aimed to evaluate the early and late outcomes of ToF repair with a transannular Contegra® monocuspid patch in a single center.

METHODS

A retrospective review of medical records was conducted. This study included 224 children with a median age of 13 months who underwent ToF repair with a Contegra® transannular patch in over 20 years of observation. The primary outcomes were hospital mortality and need for early reoperations. The secondary outcomes were late death and event-free survival.

RESULTS

The hospital mortality in our group was 3.1%, whereas two patients required early reoperation. Three patients were excluded from the study because follow-up data were not available. In the remaining group of patients (212 patients), the median follow-up was 116 (range, 1-206) months. One patient died because of sudden cardiac arrest at home six months after surgery. Event-free survival was observed in 181 patients (85.4%), whereas the remaining 30 patients (14.1%) required graft replacement. The median time to reoperation was 99 (range, 4-183) months.

CONCLUSIONS

Although surgical treatment of ToF has been performed for more than 60 years worldwide, the optimal approach in children with a hypoplastic pulmonary valve annulus remains debatable. Among options, the Contegra® monocuspid patch can be effectively used in transannular repair of ToF with good long-term results.

Implantation of monocusp valve prolongs the duration of chest tube drainage in children with tetralogy of fallot after corrective surgery

BACKGROUND

Right ventricular outflow tract obstruction relief is one of the major procedures during the total correction of tetralogy of Fallot (TOF). Pulmonary insufficiency (PI) is usually inevitable after a transannular incision with a patch repair is performed. Therefore, some surgeons advocate to place a monocusp valve within the transannular patch (TAP) in order to decrease the severity of the PI. However, the monocusp valve seemed not be very effective in some patients who underwent the complete TOF repair.

METHODS

Patients who had the classic form of TOF between January 2009 and January 2017 and underwent the corrective surgery with a TAP by the same cardiovascular surgeon were identified for further analysis. Clinical information including demographics at operation, perioperative data, and postoperative outcome were collected retrospectively and compared between the group with and without a monocusp valve.

RESULTS

A total of 24 TOF cases were included in the final analysis, and 16 (66.7%) patients received a monocusp valve placement. The patients' characteristics before and during the surgery were similar between the two groups. The median duration of chest tube drainage after the total correction in the monocusp group was longer than those without the valve (p = 0.04). There was no difference in the immediate postoperative data, including the inflammation/infection status, the duration of mechanical ventilation, and the length of ICU and hospital stay.

CONCLUSION

Implantation of a monocusp valve during the total TOF correction using a TAP did not bring benefit to improve the immediate postoperative outcomes, especially the duration of the pleural drainage. Further study with a prospective design and a larger number of cases is needed.

Pericardial Monocusp for Pulmonary Valve Reconstruction: A New Technique

Enhancing the pulmonary annulus renders the pulmonary valve incompetent in cases of tetralogy of Fallot. A pressure-loaded right ventricle may change to a volume-loaded ventricle, which may dilate and eventually dysfunction. This study evaluated a new technique of fashioning a monocusp valve from untreated autologous pericardium suspended on a transannular patch. It was assessed in 40 children undergoing complete repair of tetralogy of Fallot between January 2005 and December 2007. 24 patients had a transannular patch alone (group A) and 16 received a transannular patch with the autologous pericardial monocusp valve (group B). All patients were followed up for 1 year with transthoracic echocardiography to determine pulmonary insufficiency. There was no significant difference in cardiopulmonary bypass or aortic crossclamp times, postoperative chest tube drainage, duration of inotropic usage, intensive care unit or hospital stay between groups. Univariate analysis showed significantly lower grades of pulmonary insufficiency in group B. This technique for creating an autologous pericardial monocusp valve is an inexpensive, simple, and reliable procedure that effectively reduces pulmonary insufficiency at the 1-year follow-up.

Contegra conduit for reconstruction of the right ventricular outflow tract: a review of published early and mid-time results

Objective

The valved conduit Contegra (bovine jugular vein) has being implanted for more than 7 years in the right ventricular outflow tract and it is noted that the available reports have been mixed. The aim of this study is to review the reported evidence in the literature.

Methods

Search of the relevant literature for the primary endpoints of operative mortality and morbidity and secondary endpoints of follow-up haemodynamic performance including severe stenosis, regurgitation and need for reintervention are presented.

Results

We selected and analysed 17 series including 767 patients. Commonest indication was Fallot's tetralogy. Operative mortality was 2.6%. Operative morbidity was 13.9%. In follow-up, the incidence of intraconduit stenosis was 10.9% (incidence of stenosis for the 12 millimetre conduit was 83.3% in one series) and that of at least moderate regurgitation was 6.3%.

The aspirin users had a stenosis incidence of 10.5% compared to the non-users had a stenosis incidence of 9.6%.

Conclusion

A dissent on the performance of the Contegra is discussed, while results are satisfactory in the majority of studies apart for the smallest conduits (12 and 14 millimetre), suggesting an association to compromised run-off. The role of aspirin as antithrombotic modulator remains controversial.