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Three-step preoperative sequential planning for pulmonary valve replacement in repaired tetralogy of Fallot using computed tomography.

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.

SUBMITTER: Ferraz Cavalcanti PE

PROVIDER: S-EPMC7954262 | biostudies-literature |

REPOSITORIES: biostudies-literature

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