Surgical outcomes of total correction for tetralogy of Fallot with severe pulmonary valve annulus hypoplasia using Contegra conduit at the Cardiovascular center, E Hospital

Abstract

Objectives: To describe certain lesion characteristics in patients with Tetralogy of Fallot with severe pulmonary valve annulus hypoplasia and the surgical outcomes of complete repair for Tetralogy of Fallot using the Contegra conduit at the Cardiovascular Center, E Hospital.

Abstract: Tetralogy of Fallot is one of the most common cyanotic congenital heart diseases, and it can be surgically repaired if patient’s pulmonary artery branches are enought size. In cases of TOF with severe pulmonary valve annulus hypoplasia, where valve preservation is not feasible, various treatment strategies are available worldwide. At the Cardiovascular Center, E Hospital, since 2017 we have employed the Contegra conduit for reconstructing the right ventricular outflow tract, including the pulmonary valve and main pulmonary artery, with the option of pulmonary artery branch augmentation. This study provides a long-term evaluation of the surgical outcomes in this patient cohort. Methods: This retrospective descriptive study included 61 patients with Tetralogy of Fallot and severe pulmonary valve annulus hypoplasia who underwent complete repair using the Contegra conduit between January 2017 and December 2022 at the Cardiovascular Center, E Hospital. Results: The mean age at surgery was 7.43 ± 3.95 months, with an average weight of 7.57 ± 3.85 kg. Coronary artery anomalies were observed in 5.3% of the patients, and a patent ductus arteriosus was present in 50.9% of cases. The mean Nakata index was 201.06 ± 82.59. The average postoperative mechanical ventilation duration was 45.04 ± 33.52 hours. Six patients experienced low cardiac output syndrome. The early mortality rate was 6%, with no late deaths attributed to cardiovascular causes. During the follow-up period, 8 patients required reoperation, with a cumulative 90-month reoperation-free survival rate of 73%. Additionally, 6 cases underwent interventions for pulmonary artery main and branch dilation, and 2 cases required a Blalock-Taussig shunt. At the latest follow-up, the majority of patients (94.5%) exhibited good clinical status, classified as Ross class I. Conclusions: Complete repair of Tetralogy of Fallot with severe pulmonary valve annulus hypoplasia using the Contegra conduit yields favorable and safe outcomes