A Novel Approach for Tetralogy of Fallot-Absent Pulmonary Valve Using Bioresorbable Airway Splints

Area of Science:

• Pediatric Cardiology
• Thoracic Surgery
• Biomedical Engineering

Background:

• Tetralogy of Fallot with absent pulmonary valve (ToF-APV) often presents with severe tracheobronchomalacia (TBM), causing significant airway compromise.
• Standard treatment involves early surgical repair, including right ventricle-to-pulmonary artery conduit placement and tracheostomy, often necessitating long-term ventilator support.

Purpose of the Study:

• To evaluate the efficacy of a bioresorbable, 3D-printed airway splint in managing severe TBM in patients with ToF-APV.
• To determine if airway splinting, particularly before complete cardiac repair, can obviate the need for early conduit placement and tracheostomy.

Main Methods:

• A retrospective case series of eight patients with ToF-APV and severe TBM who underwent airway splinting between 2012 and 2021.
• Patients were analyzed based on the sequence of airway splinting relative to complete cardiac repair.

Main Results:

• All eight patients survived the follow-up period (median 3.6 years).
• Five patients who underwent cardiac repair first, and one concurrently, required tracheostomy and prolonged ventilation.
• Two patients who received airway splinting *before* cardiac repair avoided tracheostomy and prolonged ventilation (p=0.036), being discharged neonatally and returning for elective repair.

Conclusions:

• Airway splinting prior to complete cardiac repair may allow patients with ToF-APV and severe TBM to avoid early conduit placement and tracheostomy.
• This approach facilitates neonatal discharge and subsequent elective cardiac repair, improving patient management and outcomes.