Three-step preoperative sequential planning for pulmonary valve replacement in repaired tetralogy of Fallot using computed tomography. (17th November 2020)

• Record Type: Journal Article
• Authors: Ferraz Cavalcanti, Paulo Ernando; Sá, Michel Pompeu Barros Oliveira; Lins, Ricardo Felipe de Albuquerque; Cavalcanti, Catarina Vasconcelos; Lima, Ricardo de Carvalho; Cvitkovic, Tomislav; Bobylev, Dmitry; Boethig, Dietmar; Beerbaum, Philipp; Sarikouch, Samir; Haverich, Axel; Horke, Alexander
• Is Part Of: European journal of cardio-thoracic surgery. Volume 59:Number 2(2021)
• Page Start: 333
• Page End: 340
• Publication Date: 2020-11-17
• Subjects: Tetralogy of Fallot -- Pulmonary valve replacement -- Computed tomography -- Surgical planning -- Three-step preoperative sequential planning; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezaa346
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: OBJECTIVES: Our goal was to compare results between a standard computed tomography (CT)-based strategy, the 'three-step preoperative sequential planning' (3-step PSP), for pulmonary valve replacement in repaired tetralogy of Fallot versus a conventional planning approach. METHODS: We carried out a retrospective study with unmatched and matched groups. The 3-step PSP comprised the planning of mediastinal re-entry, cannulation for cardiopulmonary bypass (CPB) and the main procedure, using standard 3-dimensional videos. Operative times (skin incision to CPB, CPB time, end of CPB to skin closure and cross-clamp time) as well as postoperative length of stay and in-hospital mortality were compared. RESULTS: Eighty-two patients (49% classical tetralogy of Fallot) underwent an operation (85% with pulmonary homograft) with 1.22% in-hospital mortality. The 3-step PSP ( n = 14) and the conventional planning ( n = 68) groups were compared. There were no statistically significant differences in the preoperative characteristics. Differences were observed in the total operative time ( P = 0.009), skin incision to CPB ( P = 0.034) and cross-clamp times (74 ± 33 vs 108 ± 47 min; P = 0.006), favouring the 3-step PSP group. Eight matched pairs were compared showing differences in the total operative time (263 ± 44 vs 360 ± 66 min; P = 0.008), CPB time (123 ± 34 vs 190 ± 43 min; P = 0.008) and postoperative length of stay ( P = 0.031), favouring the 3-step PSP group. CONCLUSIONS: In patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, preoperative planning using a standard CT-based strategy, the 3-step PSP, is associated with shorter operative times and shorter postoperative length of stay. Abstract : Repeat sternotomy in heart surgery poses a major risk for undesired outcomes.