1. Ventricular function and biomarkers in relation to repair and pulmonary valve replacement for tetralogy of Fallot.
- Author
-
van der Ven JPG, Günthel M, van den Bosch E, Kamphuis VP, Blom NA, Breur J, Berger RMF, Bogers AJJC, Koopman L, Ten Harkel ADJ, Christoffels V, and Helbing WA
- Subjects
- Humans, Ventricular Function, Right physiology, Ventricular Function, Biomarkers, Tetralogy of Fallot genetics, Tetralogy of Fallot surgery, Tetralogy of Fallot complications, Pulmonary Valve diagnostic imaging, Pulmonary Valve surgery, Pulmonary Valve Insufficiency diagnostic imaging, Pulmonary Valve Insufficiency etiology, Pulmonary Valve Insufficiency surgery, Heart Valve Prosthesis Implantation adverse effects, Cardiac Surgical Procedures adverse effects, Cardiac Surgical Procedures methods
- Abstract
Objective: Cardiac surgery may cause temporarily impaired ventricular performance and myocardial injury. We aim to characterise the response to perioperative injury for patients undergoing repair or pulmonary valve replacement (PVR) for tetralogy of Fallot (ToF)., Methods: We enrolled children undergoing ToF repair or PVR from four tertiary centres in a prospective observational study. Assessment-including blood sampling and speckle tracking echocardiography-occurred before surgery (T1), at the first follow-up (T2) and 1 year after the procedures (T3). Ninety-two serum biomarkers were expressed as principal components to reduce multiple statistical testing. RNA Sequencing was performed on right ventricular (RV) outflow tract samples., Results: We included 45 patients with ToF repair aged 4.3 (3.4 - 6.5) months and 16 patients with PVR aged 10.4 (7.8 - 12.7) years. Ventricular function following ToF repair showed a fall-and-rise pattern for left ventricular global longitudinal strain (GLS) (-18±4 to -13±4 to -20±2, p < 0.001 for each comparison) and RV GLS (-19±5 to -14±4 to 20±4, p < 0.002 for each comparison). This pattern was not seen for patients undergoing PVR. Serum biomarkers were expressed as three principal components. These phenotypes are related to: (1) surgery type, (2) uncorrected ToF and (3) early postoperative status. Principal component 3 scores were increased at T2. This increase was higher for ToF repair than PVR. The transcriptomes of RV outflow tract tissue are related to patients' sex, rather than ToF-related phenotypes in a subset of the study population., Conclusions: The response to perioperative injury following ToF repair and PVR is characterised by specific functional and immunological responses. However, we did not identify factors relating to (dis)advantageous recovery from perioperative injury., Trial Registration Number: Netherlands Trial Register: NL5129., Competing Interests: Competing interests: None declared., (© Author(s) (or their employer(s)) 2023. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.)
- Published
- 2023
- Full Text
- View/download PDF