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Pulmonary Artery Hypoplasia in Neonates With Tetralogy of Fallot

Journal of the American College of Cardiology, 2023-08, Vol.82 (7), p.615-627 [Peer Reviewed Journal]

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2023.05.051 ;PMID: 37558375

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Title:
Pulmonary Artery Hypoplasia in Neonates With Tetralogy of Fallot
Author: Petit, Christopher J ; Glatz, Andrew C ; Goldstone, Andrew B ; Law, Mark A ; Romano, Jennifer C ; Maskatia, Shiraz A ; Chai, Paul J ; Zampi, Jeffrey D ; Meadows, Jeffery J ; Nicholson, George T ; Shahanavaz, Shabana ; Qureshi, Athar M ; McCracken, Courtney E ; Mascio, Christopher E ; Batlivala, Sarosh P ; Asztalos, Ivor B ; Healan, Steven J ; Smith, Justin D ; Pettus, Joelle A ; Beshish, Asaad ; Raulston, James E B ; Hock, Krissie M ; Pajk, Amy L ; Goldstein, Bryan H
Subjects: Humans ; Infant ; Infant, Newborn ; Pulmonary Artery - surgery ; Retrospective Studies ; Tetralogy of Fallot - surgery ; Treatment Outcome
Is Part Of: Journal of the American College of Cardiology, 2023-08, Vol.82 (7), p.615-627
Description: Neonates with symptomatic tetralogy of Fallot (sTOF) with hypoplastic pulmonary arteries (hPA) are considered high risk. Data are needed to inform the impact of hPA on outcomes, and the ideal management strategy. The objectives of this study were to quantify the impact of hPA on outcomes in neonates with sTOF and measure the impact of strategy on pulmonary artery (PA) growth in this population. Neonates with sTOF from 2005 to 2017 were reviewed from the Congenital Cardiac Research Collaborative. Criteria for hPA included a unilateral PA z score <-2.0 and contralateral PA z score <0. Primary outcome was mortality. Secondary outcomes included reintervention and PA growth. We included 542 neonates with sTOF, including 188 (35%) with hPA and 354 (65%) with normal PA, with median follow-up of 4.1 years. Median right and left hPA z scores were -2.19 (25th-75th percentile: -2.55 to -1.94) and -2.23 (25th-75th percentile: -2.64 to -1.91), respectively. Staged repair (vs primary TOF repair) was less common in the hPA cohort (36 vs 44%; P = 0.07). Survival was similar between groups (unadjusted P = 0.16; adjusted P = 0.25). Reintervention was more common in the hPA group (HR: 1.28; 95% CI: 1.01-1.63; P = 0.044); there was no difference after definitive repair (HR: 1.21; 95% CI: 0.93-1.58; P = 0.16). PA growth at 1 year was greater in the hPA cohort, particularly for the right PA (P < 0.001). Despite perception, the presence of hPA in neonates with sTOF conferred no increase in overall hazard of mortality or reintervention after definitive repair. PA growth was superior in the hPA cohort. These findings suggest that the presence of hPA does not adversely impact outcomes in sTOF.
Publisher: United States
Language: English
Identifier: ISSN: 0735-1097
EISSN: 1558-3597
DOI: 10.1016/j.jacc.2023.05.051
PMID: 37558375
Source: GFMER Free Medical Journals
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Pulmonary Artery Hypoplasia in Neonates With Tetralogy of Fallot

Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved. ;ISSN: 0735-1097 ;EISSN: 1558-3597 ;DOI: 10.1016/j.jacc.2023.05.051 ;PMID: 37558375

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