Skip to content
DraconiticResearch
Search Sources API
186,631 studies31 sourcesUpdated 40 min ago
Peer-reviewedCC BY 4.0Frontiers in Cardiovascular Medicine

Mid-term outcomes of right atrial appendage–derived pulmonary valve reconstruction during transannular repair of tetralogy of Fallot

  • Ahmet Kuddusi İrdem1
  • Onur Doyurgan2
  1. 1Department of Pediatric Cardiac Surgery, Ankara Bilkent City Hospital
  2. 2Department of Pediatric Cardiac Surgery, University of Health Sciences, Gazi Yaşargil Training and Research Hospital, Diyarbakır, Türkiye
Read full textDOICite

Abstract

Objectives: Transannular patch (TAP) repair remains necessary when pulmonary annular preservation is not feasible during tetralogy of Fallot (TOF) repair, but the resulting pulmonary regurgitation (PR) may contribute to progressive right ventricular volume loading and late reintervention. We evaluated early and mid-term outcomes of right atrial appendage (RAA)-derived bicuspid pulmonary valve reconstruction compared with monocusp and valve-free TAP reconstruction.

Methods: We conducted a two-center retrospective comparative cohort study of 49 patients undergoing TOF repair requiring transannular RVOT reconstruction by a single surgeon. Twenty-two patients underwent RAA-derived bicuspid pulmonary valve reconstruction, 14 underwent monocusp TAP reconstruction, and 13 underwent valve-free TAP reconstruction. The three reconstruction strategies were analyzed separately, with an additional RAA-versus-monocusp sensitivity comparison. Because age at repair differed among groups, an additional sensitivity analysis for the principal echocardiographic outcome was restricted to the overlapping age range of the RAA and monocusp groups.

Results: Median follow-up was 31.5 months (IQR, 28.0–36.0) after RAA reconstruction, 25.5 months (23.0–34.5) after monocusp TAP, and 30.0 months (26.0–36.0) after valve-free TAP ( p = 0.224). At the last available follow-up echocardiographic examination, moderate/severe PR was present in 1 of 22 patients (4.5%) after RAA reconstruction, 13 of 14 (92.9%) after monocusp TAP, and 13 of 13 (100%) after valve-free TAP ( p < 0.001). The association persisted in the direct RAA-versus-monocusp comparison (4.5% vs. 92.9%; risk ratio, 0.05; 95% CI, 0.01–0.33; Fisher's exact p < 0.001) and in the age-restricted sensitivity analysis [1/16 [6.3%] vs. 9/10 [90.0%]; Fisher's exact p < 0.001]. No patient in the RAA or monocusp group underwent pulmonary valve replacement (PVR), whereas three patients in the valve-free TAP group underwent PVR during subsequent clinical follow-up.

Conclusions: RAA-derived bicuspid pulmonary valve reconstruction was feasible and was associated with a lower prevalence of moderate/severe PR during mid-term follow-up compared with both monocusp and valve-free TAP reconstruction in this retrospective cohort. The association persisted after exclusion of the valve-free TAP group and in an age-restricted sensitivity analysis. These findings warrant confirmation in larger prospective studies with standardized longitudinal imaging and longer follow-up before conclusions regarding long-term durability, right ventricular remodeling, or PVR risk can be established.

Related

  1. Pulmonary Valve Annulus Z-Score as a Predictor of Transannular Patch Insertion in Tetralogy of Fallot Repair: A Cross-sectional Study at National Cardiovascular Center Harapan Kita
    Pribadi Wiranda Busro, Ahmad Adityawarman, Suprayitno Wardoyo +2
    Majalah Kardiologi IndonesiaPeer-reviewedCC BYFull textEpidemiology & public healthDOAJ
  2. Beyond Volume Criteria ― Individualized Approach to Pulmonary Regurgitation in Tetralogy of Fallot and Related Diseases ―
    Kenichiro Yamamura, Ayako Ishikita
    Circulation JournalPeer-reviewedCC BY-NC-NDFull textEpidemiology & public healthJ-STAGE
  3. Symptomatic Pulmonary Regurgitation Without Right Ventricular Enlargement Accompanied by Biventricular Diastolic Dysfunction in Repaired Tetralogy of Fallot and Related Diseases
    Sayuri Yamabe, Kiyomi Kayama, Yoshiro Tsuruta +14
    Circulation JournalPeer-reviewedCC BY-NC-NDFull text1 citedEpidemiology & public healthJ-STAGE
  4. Obesity in Repaired Tetralogy of Fallot: Implications for Symptoms, Right Ventricular Assessment, and Pulmonary Valve Replacement
    Giovanni Di Salvo, Elettra Pomiato, Francesca Marino +5
    Journal of Clinical MedicinePeer-reviewedCC BY 4.0General medicineCrossref
  5. Left Atrial Appendage Occlusion with the Watchman FLX Device: A Single-Centre Retrospective Analysis of Procedural and One-Year Clinical Outcomes
    Wasim Allakkis, Mostafa Salem, Mohamed Salem +6
    Medical sciences (Basel, Switzerland)Peer-reviewedCC BYFull textGeneral medicineEurope PMC

Cite

BibTeXRIS
BibTeX
@article{irdem2026midterm,
  title = {{Mid-term outcomes of right atrial appendage–derived pulmonary valve reconstruction during transannular repair of tetralogy of Fallot}},
  author = {Ahmet Kuddusi İrdem and Onur Doyurgan},
  journal = {Frontiers in Cardiovascular Medicine},
  year = {2026},
  month = nov,
  doi = {10.3389/fcvm.2026.1963919},
  url = {https://www.frontiersin.org/articles/10.3389/fcvm.2026.1963919/full},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Mid-term outcomes of right atrial appendage–derived pulmonary valve reconstruction during transannular repair of tetralogy of Fallot
AU  - Ahmet Kuddusi İrdem
AU  - Onur Doyurgan
PY  - 2026
DA  - 2026/11/02
JO  - Frontiers in Cardiovascular Medicine
DO  - 10.3389/fcvm.2026.1963919
UR  - https://www.frontiersin.org/articles/10.3389/fcvm.2026.1963919/full
AB  - Objectives: Transannular patch (TAP) repair remains necessary when pulmonary annular preservation is not feasible during tetralogy of Fallot (TOF) repair, but the resulting pulmonary regurgitation (PR) may contribute to progressive right ventricular volume loading and late reintervention. We evaluated early and mid-term outcomes of right atrial appendage (RAA)-derived bicuspid pulmonary valve reconstruction compared with monocusp and valve-free TAP reconstruction.  Methods: We conducted a two-center retrospective comparative cohort study of 49 patients undergoing TOF repair requiring transannular RVOT reconstruction by a single surgeon. Twenty-two patients underwent RAA-derived bicuspid pulmonary valve reconstruction, 14 underwent monocusp TAP reconstruction, and 13 underwent valve-free TAP reconstruction. The three reconstruction strategies were analyzed separately, with an additional RAA-versus-monocusp sensitivity comparison. Because age at repair differed among groups, an additional sensitivity analysis for the principal echocardiographic outcome was restricted to the overlapping age range of the RAA and monocusp groups.  Results: Median follow-up was 31.5 months (IQR, 28.0–36.0) after RAA reconstruction, 25.5 months (23.0–34.5) after monocusp TAP, and 30.0 months (26.0–36.0) after valve-free TAP ( p = 0.224). At the last available follow-up echocardiographic examination, moderate/severe PR was present in 1 of 22 patients (4.5%) after RAA reconstruction, 13 of 14 (92.9%) after monocusp TAP, and 13 of 13 (100%) after valve-free TAP ( p < 0.001). The association persisted in the direct RAA-versus-monocusp comparison (4.5% vs. 92.9%; risk ratio, 0.05; 95% CI, 0.01–0.33; Fisher's exact p < 0.001) and in the age-restricted sensitivity analysis [1/16 [6.3%] vs. 9/10 [90.0%]; Fisher's exact p < 0.001]. No patient in the RAA or monocusp group underwent pulmonary valve replacement (PVR), whereas three patients in the valve-free TAP group underwent PVR during subsequent clinical follow-up.  Conclusions: RAA-derived bicuspid pulmonary valve reconstruction was feasible and was associated with a lower prevalence of moderate/severe PR during mid-term follow-up compared with both monocusp and valve-free TAP reconstruction in this retrospective cohort. The association persisted after exclusion of the valve-free TAP group and in an age-restricted sensitivity analysis. These findings warrant confirmation in larger prospective studies with standardized longitudinal imaging and longer follow-up before conclusions regarding long-term durability, right ventricular remodeling, or PVR risk can be established.
SN  - 2297-055X
ER  -