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Three-step preoperative sequential planning for pulmonary valve replacement in repaired tetralogy of Fallot using computed tomography
- Source :
- European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
- Publication Year :
- 2020
- Publisher :
- Oxford University Press, 2020.
-
Abstract
- OBJECTIVES Our goal was to compare results between a standard computed tomography (CT)-based strategy, the ‘three-step preoperative sequential planning’ (3-step PSP), for pulmonary valve replacement in repaired tetralogy of Fallot versus a conventional planning approach. METHODS We carried out a retrospective study with unmatched and matched groups. The 3-step PSP comprised the planning of mediastinal re-entry, cannulation for cardiopulmonary bypass (CPB) and the main procedure, using standard 3-dimensional videos. Operative times (skin incision to CPB, CPB time, end of CPB to skin closure and cross-clamp time) as well as postoperative length of stay and in-hospital mortality were compared. RESULTS Eighty-two patients (49% classical tetralogy of Fallot) underwent an operation (85% with pulmonary homograft) with 1.22% in-hospital mortality. The 3-step PSP (n = 14) and the conventional planning (n = 68) groups were compared. There were no statistically significant differences in the preoperative characteristics. Differences were observed in the total operative time (P = 0.009), skin incision to CPB (P = 0.034) and cross-clamp times (74 ± 33 vs 108 ± 47 min; P = 0.006), favouring the 3-step PSP group. Eight matched pairs were compared showing differences in the total operative time (263 ± 44 vs 360 ± 66 min; P = 0.008), CPB time (123 ± 34 vs 190 ± 43 min; P = 0.008) and postoperative length of stay (P = 0.031), favouring the 3-step PSP group. CONCLUSIONS In patients with repaired tetralogy of Fallot undergoing pulmonary valve replacement, preoperative planning using a standard CT-based strategy, the 3-step PSP, is associated with shorter operative times and shorter postoperative length of stay.<br />Repeat sternotomy in heart surgery poses a major risk for undesired outcomes.
- Subjects :
- Pulmonary and Respiratory Medicine
medicine.medical_specialty
Eacts/140
Computed tomography
030204 cardiovascular system & hematology
Surgical planning
Preoperative care
law.invention
03 medical and health sciences
Congenital
0302 clinical medicine
law
Pulmonary Valve Replacement
Cardiopulmonary bypass
medicine
Eacts/139
Tetralogy of Fallot
medicine.diagnostic_test
Eacts/132
business.industry
AcademicSubjects/MED00920
Retrospective cohort study
General Medicine
medicine.disease
Surgery
030228 respiratory system
Pulmonary valve replacement
Three-step preoperative sequential planning
Planning approach
Eacts/129
Cardiology and Cardiovascular Medicine
business
Subjects
Details
- Language :
- English
- ISSN :
- 1873734X and 10107940
- Volume :
- 59
- Issue :
- 2
- Database :
- OpenAIRE
- Journal :
- European Journal of Cardio-Thoracic Surgery : Official Journal of the European Association for Cardio-thoracic Surgery
- Accession number :
- edsair.doi.dedup.....40b10f8e1bd45c0fc20ebc026c67123c