Open Access

ARTICLE

Monocusp valve placement in children with tetralogy of Fallot undergoing repair with transannular patch: A functioning pulmonary valve does not improve immediate postsurgical outcomes

Nikki M. Singh¹, Rohit S. Loomba², Todd M. Gudausky¹, Michael E. Mitchell³

1 Division of Pediatric Cardiology, Medical College of Wisconsin, Herma Heart Institute at Children’s Hospital of Wisconsin, Milwaukee, Wisconsin
2 Advocate Children’s Heart Institute, Advocate Children’s Hospital, Oak Lawn, Illinois
3 Division of Pediatric Cardiothoracic Surgery, Medical College of Wisconsin, Herma Heart Institute at Children’s Hospital of Wisconsin, Milwaukee, Wisconsin

* Corresponding Author: Nikki M. Singh, MD Herma Heart Institute and Children’s Hospital of Wisconsin, 9000 W. Wisconsin Ave, MS 713, Milwaukee, WI 53226. Email:

Congenital Heart Disease 2018, 13(6), 935-943. https://doi.org/10.1111/chd.12670

Abstract

Introduction: In patients with tetralogy of Fallot (TOF), use of transannular patch (TAP) may be required in order to relieve significant right ventricular outflow tract obstruction, subsequently resulting in pulmonary insufficiency (PI). The monocusp valve has been used to temporarily reduce insufficiency in hopes to improve short and midterm outcomes. The purpose of this study was to assess for potential benefits of the monocusp valve in this subset of patients.
Design: Between 2005 and 2016, 119 patients with TOF with pulmonary stenosis who underwent repair with TAP were analyzed, 43 (36.1%) had a monocusp valve placed. Immediate outcomes were assessed by postoperative echocardiograms, ICU data including time to extubation, chest tube duration, reintervention, length of stay, and mortality.
Results: Median age of repair was similar for monocusp group at 143.5 days and nonmonocusp at 137.0 days (P = .93). Peak preoperative right ventricular outflow tract obstruction was higher in the monocusp group (80 mm Hg vs. 70 mm Hg, P ≤ .01). Patients who had monocusp placed had longer bypass time. There was less PI for monocusp group immediately after repair and at discharge (P ≤ .01). There was no difference in days of intubation, chest tube duration, length of hospitalization, reintervention rates, or mortality.
Conclusion: Decreasing the degree of PI with a monocusp valve in patients undergoing repair for TOF repair with TAP does not improve clinical outcomes in the immediate postoperative period.

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