Article Abstract

The problems related with primary repair for tetralogy of Fallot, especially about transannular patch repair

Authors: Atsushi Mizuno, Koichiro Niwa


Since the initial surgical correction of tetralogy of Fallot (TOF) in 1954, advances in management have helped reduce early surgical mortality to less than 2% (1). During six decades, the surgical approach has shifted from repair via a right ventriculotomy to a transatrial-transpulmonary approach, as many congenital cardiac surgeons consider relieving right ventricular outflow tract (RVOT) obstruction with preserving pulmonary valve competence as important factors to guarantee long term outcomes (2-4). The STS database reported the recent trend in TOF operations, which revealed over 60% surgeries still using transannular patch enlargement (TAPE) (5). These data suggested us to consider the reason of using TAPE. Recent trends revealed many centers used the pulmonary valve annulus (PVA) z-score to determine whether to apply the TAPE procedure, but the cutoff value for this measure varies among studies (−1.3 to −4) (6,7).