The impact of native Fallot anatomy on future therapeutic requirements and outcomes at follow-up

Antonio Ravaglioli, Lamia Ait-Ali, Duccio Federici, Stefano Salvadori, Arketa Pllumi, Vitali Pak, Chiara Marrone, Alessandra Pizzuto, Philipp Bonhoeffer, Pierluigi Festa, Antonio Ravaglioli, Lamia Ait-Ali, Duccio Federici, Stefano Salvadori, Arketa Pllumi, Vitali Pak, Chiara Marrone, Alessandra Pizzuto, Philipp Bonhoeffer, Pierluigi Festa

Abstract

Background: In patients with repaired Fallot, subsequent surgical or interventional procedures and adverse cardiac events are frequent. We aimed to evaluate the impact of a simple pre-operative anatomic classification based on the size of the pulmonary valve (PV) annulus and branches on future therapeutic requirements and outcomes.

Method: This is a single-center retrospective analysis of patients operated for Fallot before the age of 2 years, from January 1990. Pre-operative anatomy, surgical and interventional procedures and adverse events were extrapolated from clinical records.

Results: Among the 312 patients, a description of the PV and pulmonary arteries (PAs) native anatomy was known in 239 patients (male:147, 61.5%), which were divided in the following 3 groups: group 1 (65 patients) with normal size of both PV and PAs; group 2 (108 patients) with PV hypoplasia but normal size PAs; group 3 (66 patients) with concomitant hypoplasia of the PV and PAs. During the 12.7 years (IQR 6.7-17) follow-up time, 23% of patients required at least one surgical or interventional procedure. At Kaplan-Meier analysis, there was a significant difference in requirement of future surgical or interventional procedures among the 3 groups (p < 0,001). At multivariate Cox regression analysis, hypoplasia of PV and PAs was an independent predictor of subsequent procedures (HR:3.1,CI:1.06-9.1, p = 0.03).

Conclusion: Native anatomy in Tetralogy of Fallot patients affects surgical strategy and follow-up. It would be therefore advisable to tailor patient's counseling and follow-up according to native anatomy, rather than following a standardized protocol.

Keywords: Follow-up; Native anatomy; Surgical/interventional procedure; Tetralogy of Fallot.

Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Kaplan–Meier freedom from any surgical or interventional procedure in group 1, 2 and 3
Fig. 2
Fig. 2
Kaplan–Meier freedom from surgical re-operation in group 1, 2 and 3
Fig. 3
Fig. 3
Kaplan–Meier freedom from interventional procedure in group 1, 2 and 3

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