A retrospective observational study of tetralogy of fallot with pulmonary atresia and ductal-dependent pulmonary circulation focusing on the staged transannular patch procedure: a single-center study.

Abstract

Background: Management of pulmonary atresia with ventricular septal defect and ductal-dependent pulmonary circulation (PA/VSD/PDA) varies according to pulmonary artery morphology and institutional surgical strategy. We adopted a range of initial palliative surgical options for patients with PA/VSD/PDA and evaluated the effectiveness of our management strategy.

Methods: Twenty-five patients with PA/VSD/PDA were enrolled between May 2015 and July 2023. Patients with major aortopulmonary collateral arteries were excluded. The mean age at initial surgery was 14.9 ± 13.7 days, and the mean weight was 3.17 ± 0.35 kg. Twenty-two (88%) patients were neonates. Nineteen patients underwent initial palliative systemic-to-pulmonary shunt, while six underwent an initial definitive Rastelli operation depending on the main pulmonary artery morphology and branch pulmonary arteries size.

Results: One patient died of postoperative brain hemorrhage following the initial definitive Rastelli operation. The mean follow-up duration was 58.5 ± 28.4 months. During follow-up, one patient died suddenly two months after the initial central shunt procedure. All surviving patients with a shunt, except two, underwent biventricular repair: ten with the Rastelli operation and six with the transannular patch (TAP) procedure. The staged TAP group demonstrated a significantly larger freedom from reoperation rate than that of the initial Rastelli operation group (p = 0.022) and a significantly lower catheter-based reintervention rate than that of the other two management groups (p = 0.011).

Conclusions: A management strategy using an initial definitive Rastelli operation or systemic-to-pulmonary shunt based on main pulmonary artery development and branch pulmonary arteries size is safe and effective for PA/VSD/PDA treatment. The staged TAP procedure could be a viable option for patients with PA/VSD/PDA and a well-developed main pulmonary artery segment.

Trial registration: Not applicable.