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Master Thesis

Évaluation précoce de la plastie valvulaire pulmonaire après cure complète de tétralogie de Fallot

Abstract : Introduction: repair of Tetralogy of Fallot has an excellent prognosis with life expectancy close to the general population. Unfortunately, it is no devoid of surgical complications related to type of repair. In order to relieve the right ventricular outflow tract, a majority of patients undergo pulmonary valve repair with reconstruction by transannular patch. Resulting pulmonary insufficiency is associated with late right ventricular dysfunction and poor prognostic. In the immediate postoperative period pulmonary insufficiency may be poorly tolerated and induce acute right heart failure and dysfunction of organ. Objective: compare immediate outcomes of transannular patch repair and monocusp groups. Methods: 67 patients, 6 months old, with tetralogy of Fallot and hypoplasia of the right ventricular outflow tract underwent complete repair between 2008 and 2019 by two techniques. 23 patients had the conventional transannular patch repair and monocusp was used in 44 patients. Clinical data including mortality, length of intensive care unit stay, length of stay in hospital, mechanical ventilation time, dialysis, chest drainage time, VIS score, reinterventions and postoperative complications were collected. Immediate outcomes were assessed by biological data and postoperative echocardiogram. Results: demographic and preoperative data was similar in two groups. The intensive care unit stay was significantly lower in the monocusp group (5 days vs 8 days, p-value<0,05). No mortality to report in both groups. Patients repaired with monocusp required less and shorter dialysis (65% vs 35%, p-value=0,13, 38 hours vs 12 hours, p-value<0,05). The inotropic support of the right ventricle was significantly lower in the monocusp group compared to classic transannular patch. Patients repaired with monocusp underwent longer cardiopulmonary bypass and crossclamp but it was associated with a lower postoperative complication rate and freedom from reintervention. Transthoracic echocardiography performed before discharge from the hospital reported less pulmonary insufficiency in the monocusp group. Conclusion: surgical replacement of the native pulmonary valve by monocusp as part of a complete Tetralogy of Fallot repair can accelerate postoperative rehabilitation, reduce length of stay in intensive care unit, the use of dialysis and improving the quality of postoperative follow-up.
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https://dumas.ccsd.cnrs.fr/dumas-03563068
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Submitted on : Wednesday, February 9, 2022 - 2:07:11 PM
Last modification on : Tuesday, February 15, 2022 - 3:43:10 AM
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Tiphaine Bridier. Évaluation précoce de la plastie valvulaire pulmonaire après cure complète de tétralogie de Fallot. Sciences du Vivant [q-bio]. 2020. ⟨dumas-03563068⟩

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