Mid-Term Outcomes After Unifocalization Guided by Intraoperative Pulmonary Flow Study

Area of Science:

• Cardiovascular Surgery
• Pediatric Cardiology

Background:

• Tetralogy of Fallot (TOF) with major aortopulmonary collateral arteries (MAPCAs) repair involves complex unifocalization and reconstruction.
• Intraoperative flow studies can aid in assessing the feasibility of complete repair by estimating pulmonary circulation resistance.

Purpose of the Study:

• To evaluate outcomes of TOF/MAPCAs repair with and without intraoperative flow studies.
• To assess the correlation between intraoperative pulmonary artery (PA) pressure during flow study and postoperative right ventricle (RV) pressure.

Main Methods:

• Retrospective review of 579 patients undergoing unifocalization and PA reconstruction for TOF/MAPCAs.
• Analysis of 99 patients (17%) who underwent intraoperative flow studies to guide complete repair decisions.

Main Results:

• A good correlation was observed between mean PA pressure during flow study and postrepair RV pressure/RV:aortic pressure ratio.
• Acute and mid-term outcomes did not differ significantly between patients with and without flow studies.
• Prior failed flow studies did not impact outcomes of subsequent intracardiac repair.

Conclusions:

• Intraoperative flow studies are valuable for selecting patients for complete repair of TOF/MAPCAs.
• The study provides accurate estimation of postoperative PA pressure, guiding single-stage repair feasibility.
• Flow studies serve as a reliable adjunct in complex TOF/MAPCAs surgical decision-making.