Mendes Vitor, Mouloudi Abdelkhalek, Jolou Jalal, Nalecz Tomasz, Abecasis Ana, Pereira Telmo, Sologashvili Tornike
Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), Geneva, 1211, Switzerland.
Global Health and Tropical Medicine, Institute of Hygiene and Tropical Medicine, NOVA University of Lisbon (IHMT-UNL), Lisbon, Portugal.
J Cardiothorac Surg. 2025 May 28;20(1):243. doi: 10.1186/s13019-025-03475-x.
The optimal surgical approach for right ventricular outflow tract obstruction in Tetralogy of Fallot aims to preserve the native pulmonary valve annulus, as this is associated with better long-term outcomes. Pediatric humanitarian patients often present with a delayed diagnosis and lack access to preoperative palliative treatments, reducing the likelihood of pulmonary valve annulus preservation and potentially compromising long-term outcomes. This study aims to identify independent predictors of successful pulmonary valve-sparing repair in pediatric humanitarian patients undergoing corrective surgery for Tetralogy of Fallot.
Between January 2019 and May 2023, pediatric humanitarian patients with Tetralogy of Fallot underwent surgical correction at our center. We performed a comparative analysis of preoperative, intraoperative, and postoperative variables, followed by univariate and multivariate logistic regression to identify independent predictors of pulmonary valve-sparing repair.
A lower body mass index (OR = 0.711; p = 0.021; 95% CI = 0.533-0.949), a larger pulmonary valve annulus measured in centimeters (OR = 28.653; p = 0.008; 95% CI = 2.360-347.890) and a higher Z-score of pulmonary valve annulus (OR = 1.606; p = 0.023; 95% CI = 1.067-2.418) were identified as independent predictors of pulmonary valve-sparing repair.
Successful pulmonary valve-sparing repair was associated with lower BMI and a larger pulmonary valve annulus (both measurements in centimeters and Z-score). These findings may help guide clinical and policy strategies to promote more equitable and effective surgical care in resource-limited settings.
法洛四联症右心室流出道梗阻的最佳手术方法旨在保留天然肺动脉瓣环，因为这与更好的长期预后相关。儿科人道主义患者常常诊断延迟且无法获得术前姑息治疗，这降低了保留肺动脉瓣环的可能性，并可能影响长期预后。本研究旨在确定接受法洛四联症矫正手术的儿科人道主义患者中成功进行保留肺动脉瓣修复的独立预测因素。
2019年1月至2023年5月期间，患有法洛四联症的儿科人道主义患者在我们中心接受了手术矫正。我们对术前、术中和术后变量进行了比较分析，然后进行单因素和多因素逻辑回归以确定保留肺动脉瓣修复的独立预测因素。
较低的体重指数（OR = 0.711；p = 0.021；95%CI = 0.533 - 0.949）、以厘米为单位测量的较大肺动脉瓣环（OR = 28.653；p = 0.008；95%CI = 2.360 - 347.890）以及较高的肺动脉瓣环Z评分（OR = 1.606；p = 0.023；95%CI = 1.067 - 2.418）被确定为保留肺动脉瓣修复的独立预测因素。
成功的保留肺动脉瓣修复与较低的体重指数以及较大的肺动脉瓣环（以厘米为单位测量和Z评分）相关。这些发现可能有助于指导临床和政策策略，以在资源有限的环境中促进更公平和有效的手术治疗。
