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
- 1Department of Pediatric and Congenital Heart Surgery, National Cardiovascular Center Harapan Kita/Division of Thoracic, Cardiac, and Vascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- 2Division of Thoracic, Cardiac, and Vascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
- 3Pediatric Cardiology and Congenital Heart Disease Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia
Abstract
Background: The use of a Transannular Patch (TAP) in the surgical repair of Tetralogy of Fallot (TOF) can improve Right Ventricular Outflow Tract (RVOT) flow but may increase the risk of long-term pulmonary insufficiency. Therefore, the decision to use TAP is critical. The Pulmonary Valve Annulus (PVA) diameter z-score is commonly used to predict TAP insertion; however, no z-score threshold has been established in Indonesia. This study sought to investigate whether the preoperative z-score of PVA diameter predicts the use of TAP during TOF repair surgery.
Methods: This cross-sectional study utilized data from 101 TOF patients who underwent TOF repair at National Cardiovascular Center Harapan Kita between January 2023 and December 2024. Patients were divided into two groups based on TAP usage (Yes: n = 65; No: n = 36). Preoperative PVA diameter was obtained from cardiac Multislice Computed Tomography (MSCT). Multivariate logistic regression was performed, and Receiver Operating Characteristic (ROC) curve analyses were conducted to determine the optimal cutoff thresholds.
Results: Multivariate analysis showed the z-score of PVA minimal diameter was significantly associated with TAP usage (Odds Ratio [OR] 0.450, 95% Confidence Interval [CI] 0.297 to 0.683, P < 0.001). A preoperative minimum PVA diameter z-score cut-off of -1.6 yielded a sensitivity of 75.4% and a specificity of 61.1%.
Conclusions: The z-score of the PVA diameter may serve as a useful predictor in planning an appropriate surgical strategy in ToF repair, particularly regarding the decision to use a TAP.
Related
- Mid-term outcomes of right atrial appendage–derived pulmonary valve reconstruction during transannular repair of tetralogy of Fallot
- Harmony™ Valve Implantation in the Right Pulmonary Artery in a Patient with Repaired Tetralogy of Fallot and Left Pulmonary Artery Occlusion: A Case Report☆
- Beyond Volume Criteria ― Individualized Approach to Pulmonary Regurgitation in Tetralogy of Fallot and Related Diseases ―
- Symptomatic Pulmonary Regurgitation Without Right Ventricular Enlargement Accompanied by Biventricular Diastolic Dysfunction in Repaired Tetralogy of Fallot and Related Diseases
- Obesity in Repaired Tetralogy of Fallot: Implications for Symptoms, Right Ventricular Assessment, and Pulmonary Valve Replacement
BibTeX
@article{busro2026pulmonary,
title = {{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}},
author = {Pribadi Wiranda Busro and Ahmad Adityawarman and Suprayitno Wardoyo and Olfi Lelya and Oktavia Lilyasari},
journal = {Majalah Kardiologi Indonesia},
year = {2026},
month = oct,
doi = {10.30701/ijc.2140},
url = {https://doi.org/10.30701/ijc.2140},
note = {CC BY},
}
RIS
TY - JOUR
TI - 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
AU - Pribadi Wiranda Busro
AU - Ahmad Adityawarman
AU - Suprayitno Wardoyo
AU - Olfi Lelya
AU - Oktavia Lilyasari
PY - 2026
DA - 2026/10/25
JO - Majalah Kardiologi Indonesia
DO - 10.30701/ijc.2140
UR - https://doi.org/10.30701/ijc.2140
AB - Background: The use of a Transannular Patch (TAP) in the surgical repair of Tetralogy of Fallot (TOF) can improve Right Ventricular Outflow Tract (RVOT) flow but may increase the risk of long-term pulmonary insufficiency. Therefore, the decision to use TAP is critical. The Pulmonary Valve Annulus (PVA) diameter z-score is commonly used to predict TAP insertion; however, no z-score threshold has been established in Indonesia. This study sought to investigate whether the preoperative z-score of PVA diameter predicts the use of TAP during TOF repair surgery. Methods: This cross-sectional study utilized data from 101 TOF patients who underwent TOF repair at National Cardiovascular Center Harapan Kita between January 2023 and December 2024. Patients were divided into two groups based on TAP usage (Yes: n = 65; No: n = 36). Preoperative PVA diameter was obtained from cardiac Multislice Computed Tomography (MSCT). Multivariate logistic regression was performed, and Receiver Operating Characteristic (ROC) curve analyses were conducted to determine the optimal cutoff thresholds. Results: Multivariate analysis showed the z-score of PVA minimal diameter was significantly associated with TAP usage (Odds Ratio [OR] 0.450, 95% Confidence Interval [CI] 0.297 to 0.683, P < 0.001). A preoperative minimum PVA diameter z-score cut-off of -1.6 yielded a sensitivity of 75.4% and a specificity of 61.1%. Conclusions: The z-score of the PVA diameter may serve as a useful predictor in planning an appropriate surgical strategy in ToF repair, particularly regarding the decision to use a TAP.
SN - 0126-3773
SN - 2620-4762
ER -