Optimal Z-Score Use in Surgical Decision-Making in Pulmonary Atresia With Intact Ventricular Septum.

Area of Science:

• Pediatric Cardiology
• Congenital Heart Surgery
• Medical Imaging & Diagnostics

Background:

• Tricuspid valve annulus z-scores are critical in surgical decisions for pulmonary atresia with intact ventricular septum.
• Existing literature shows significant variation in reported z-score cutoffs for successful biventricular repair.

Purpose of the Study:

• To investigate if differing z-score data sets contribute to the wide range of reported cutoffs for biventricular repair in pulmonary atresia with intact ventricular septum.
• To clarify the impact of z-score data set selection on surgical pathway allocation.

Main Methods:

• A PubMed search was conducted using specific terms for pulmonary atresia, intact septum, and z-scores.
• Included studies that specified the z-score data set used in patients undergoing biventricular repair.
• Analyzed data from 13 articles encompassing 1,392 patients.

Main Results:

• Out of 1,392 patients, 410 (29.5%) underwent successful biventricular repair.
• Mean tricuspid valve annulus z-scores in biventricular repair patients varied widely (-0.53 to -5.1) across three reported data sets.
• After data set correction, no study reported a mean z-score below -2.8, and 83.3% reported means above -1.7.

Conclusions:

• Discrepancies in tricuspid valve annulus z-score data sets likely contribute to variations in reported biventricular repair cutoffs.
• Inconsistent use of z-score data sets may lead to suboptimal surgical approach selection for patients with pulmonary atresia and intact ventricular septum.