PMID- 34313740 OWN - NLM STAT- MEDLINE DCOM- 20220103 LR - 20220103 IS - 2574-3805 (Electronic) IS - 2574-3805 (Linking) VI - 4 IP - 7 DP - 2021 Jul 1 TI - Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot. PG - e2118141 LID - 10.1001/jamanetworkopen.2021.18141 [doi] LID - e2118141 AB - IMPORTANCE: The choice of the right surgical technique for correction of tetralogy of Fallot (TOF) is contentious for patients with a moderate to severe right outflow tract obstruction. The use of a transannular patch (TAP) exposes patients to chronic pulmonary regurgitation, while valve-sparing (VS) procedures may incompletely relieve pulmonary obstruction. OBJECTIVE: To compare 30-year outcomes of TOF repair after a VS procedure vs TAP. DESIGN, SETTING, AND PARTICIPANTS: This retrospective population-based cohort study was conducted among all patients with TOF born in the province of Quebec, Canada, from 1980 to 2015 who underwent complete surgical repair. Patients who received a TAP or VS procedure were matched using a propensity score based on preoperative factors in a 1:1 ratio. Data were analyzed from March 2020 through April 2021. EXPOSURES: The study groups were individuals who received TAP and those who received VS. The VS group was further stratified by the presence of residual pulmonary stenosis. MAIN OUTCOMES AND MEASURES: The primary outcome was all-cause mortality, with 30-year survival evaluated using Cox proportional-hazards models. Secondary outcomes included the cumulative mean number of cardiovascular interventions, pulmonary valve replacements (PVRs), and cardiovascular hospitalizations were evaluated using marginal means/rates regressions. RESULTS: Among 683 patients with TOF (401 patients who underwent TAP [58.7%] and 282 patients who underwent a VS procedure [41.3%]), adequate propensity score matching was achieved for 528 patients (264 patients who underwent a VS procedure and 264 patients who underwent TAP). Among this study cohort, 307 individuals (58.1%) were men. The median (interquartile range [IQR]) follow-up was 16.0 (8.1-25.4) years, for a total of 8881 patient-years, including 63 individuals (11.9%) followed up for more than 30 years. Individuals who received a VS procedure had an increased 30-year survival of 99.1% compared with 90.4% for individuals who received TAP (hazard ratio [HR], 0.09 [95% CI, 0.02-0.41]; P = .002). Patients who underwent TAP had an increased 30-year cumulative mean number of cardiovascular interventions compared with patients who underwent a VS procedure without residual pulmonary stenosis (2.0 interventions [95% CI, 1.5-2.7 interventions] vs 0.7 interventions [95% CI, 0.5-1.1 interventions]; mean ratio [MR], 0.36 [95% CI, 0.25-0.50]; P < .001) and patients who underwent a VS procedure with at least moderate residual stenosis (1.3 interventions [95% CI, 0.9-1.9 interventions]; MR, 0.65 [0.45-0.93]; P = .02). Results were similar for PVR, with a 30-year cumulative mean 0.3 PVRs [95% CI, 0.1-0.7 PVRs] for patients who underwent a VS procedure without residual pulmonary stenosis (MR, 0.22 [95% CI, 0.12-0.43]; P < .001) and 0.6 PVRs (95% CI, 0.2-1.5 PVRs) for patients with at least moderate residual stenosis (MR, 0.44 [95% CI, 0.21-0.93]; P = .03), compared with 1.4 PVRs (95% CI, 0.8-2.5 PVRs) for the TAP group. No statistically significant difference was found for cardiovascular hospitalizations. CONCLUSIONS AND RELEVANCE: This study found that patients who underwent a VS procedure had increased 30-year survival, fewer cardiovascular reinterventions, and fewer PVRs compared with individuals who underwent TAP, even in the presence of significant residual pulmonary stenosis. These findings suggest that it is beneficial to perform a VS procedure when possible, even in the presence of moderate residual stenosis, compared with the insertion of a TAP. FAU - Blais, Samuel AU - Blais S AD - Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada. AD - Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. FAU - Marelli, Ariane AU - Marelli A AD - McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montreal, Quebec, Canada. FAU - Vanasse, Alain AU - Vanasse A AD - Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. AD - Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada. FAU - Dahdah, Nagib AU - Dahdah N AD - Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Quebec, Canada. FAU - Dancea, Adrian AU - Dancea A AD - Division of Pediatric Cardiology, McGill University Health Centre, Montreal, Quebec, Canada. FAU - Drolet, Christian AU - Drolet C AD - Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Quebec, Quebec, Quebec, Canada. FAU - Dallaire, Frederic AU - Dallaire F AD - Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Quebec, Canada. AD - Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada. LA - eng PT - Comparative Study PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20210701 PL - United States TA - JAMA Netw Open JT - JAMA network open JID - 101729235 SB - IM MH - Adult MH - Aged MH - Cardiac Valve Annuloplasty/methods/*mortality MH - Female MH - Hospitalization/statistics & numerical data MH - Humans MH - Male MH - Middle Aged MH - Organ Sparing Treatments/methods/*mortality MH - Postoperative Complications/etiology/*mortality/surgery MH - Propensity Score MH - Proportional Hazards Models MH - Pulmonary Valve/surgery MH - Pulmonary Valve Insufficiency/etiology/mortality/surgery MH - Pulmonary Valve Stenosis/etiology/*mortality/surgery MH - Quebec MH - Reoperation/methods/mortality MH - Retrospective Studies MH - Survival Rate MH - Tetralogy of Fallot/complications/mortality/*surgery MH - Treatment Outcome PMC - PMC8317016 COIS- Conflict of Interest Disclosures: None reported. EDAT- 2021/07/28 06:00 MHDA- 2022/01/04 06:00 PMCR- 2021/07/27 CRDT- 2021/07/27 12:26 PHST- 2021/07/27 12:26 [entrez] PHST- 2021/07/28 06:00 [pubmed] PHST- 2022/01/04 06:00 [medline] PHST- 2021/07/27 00:00 [pmc-release] AID - 2782416 [pii] AID - zoi210535 [pii] AID - 10.1001/jamanetworkopen.2021.18141 [doi] PST - epublish SO - JAMA Netw Open. 2021 Jul 1;4(7):e2118141. doi: 10.1001/jamanetworkopen.2021.18141.