Right ventricular functional recovery depends on timing of pulmonary valve replacement in tetralogy of Fallot: a video kinematic study. (6th February 2021)

• Record Type: Journal Article
• Authors: Rozzi, Giacomo; Lo Muzio, Francesco Paolo; Fassina, Lorenzo; Rossi, Stefano; Statello, Rosario; Sandrini, Camilla; Laricchiuta, Maira; Faggian, Giuseppe; Miragoli, Michele; Luciani, Giovanni Battista
• Is Part Of: European journal of cardio-thoracic surgery. Volume 59:Number 6(2021)
• Page Start: 1329
• Page End: 1336
• Publication Date: 2021-02-06
• Subjects: Tetralogy of Fallot -- Pulmonary valve replacement -- Video kinematic evaluation -- Magnetic resonance imaging; Heart -- Surgery -- Periodicals; Chest -- Surgery -- Periodicals; 617.54
• DOI: 10.1093/ejcts/ezab026
• Languages: English
• ISSNs: 1010-7940

Abstract

Abstract: : OBJECTIVES: Indications for and timing of pulmonary valve replacement (PVR) after tetralogy of Fallot repair are controversial. Among magnetic resonance imaging indices proposed to time valve replacement, a right ventricular (RV) end-diastolic volume index greater than 160 ml/m 2 is often used. Recent evidence suggests that this value may still identify patients with irreversible RV dysfunction, thus hindering recovery. Our goal was to define, using intraoperative video kinematic evaluation, whether a relationship exists between timing of PVR and early functional recovery after surgery. METHODS: Between November 2016 and November 2018, a total of 12 consecutive patients aged 27.1 ± 19.1 years underwent PVR on average 22.2 ± 13.3 years after tetralogy of Fallot repair. Mean RV end-diastolic volume evident on the magnetic resonance images was 136.9 ± 35.7 ml/m 2 . Intraoperative cardiac kinematics were assessed by video kinematic evaluation via a high-speed camera acquiring videos at 200 fps before and after valve replacement. RESULTS: Patients presenting with RV end-diastolic volume <147 ml/m 2 were significantly younger (11.2 ± 5.0 vs 38.4 ± 17.0; P = 0.005) and had a shorter time interval to valve replacement (11.0 ± 5.2 vs 30.1 ± 11.3; P = 0.03). The entire population showed a moderate correlation among energy expenditure, cardiac fatigue, perimeter of contraction and preoperative RV end-diastolic volume index. Both groups showed a reduction in all kinematic parameters after PVR, but those with end-diastolic volume >147 ml/m 2 showed an unpredictable outcome. CONCLUSIONS: Video kinematic evaluation provides insight into intraoperative RV recovery in patients with tetralogy of Fallot undergoing PVR. Accordingly, functional recovery can be expected in patients with preoperative end-diastolic volume <147 ml/m 2 .