@Article{chd.12863,
AUTHOR = {Mary K. Olive, Charles D. Fraser, Shelby Kutty, Emmett D. McKenzie, James M. Hammel, Rajesh Krishnamurthy, Nicolas A. Dodd, Shiraz A. Maskatia},
TITLE = {Infundibular sparing versus transinfundibular approach to the repair of tetralogy of Fallot},
JOURNAL = {Structural and Congenital Heart Disease},
VOLUME = {14},
YEAR = {2019},
NUMBER = {6},
PAGES = {1149--1156},
URL = {http://www.techscience.com/schd/v14n6/38932},
ISSN = {3071-1738},
ABSTRACT = {<b>Introduction:</b> The right ventricular infundibular sparing approach (RVIS) to the repair 
of tetralogy of Fallot (TOF) avoids a full-thickness ventricular incision, typically utilized in the transinfundibular (TI) method.<br/>
<b>Methods:</b> We performed a retrospective, age-matched cohort study of patients who 
underwent RVIS at Texas Children’s Hospital or TI at Children’s Hospital Medical 
Center in Nebraska and subsequently underwent cardiac magnetic resonance imaging 
(CMR). We compared right ventricular end-diastolic and systolic volumes indexed to 
body surface area (RVEDVi and RVESVi) and right ventricular ejection fraction (RVEF) 
as primary endpoints. Secondary endpoints were indexed left ventricular diastolic and 
systolic volume (LVEDVi and LVESVi), left ventricular ejection fraction (LVEF), right 
ventricular (RV) sinus ejection fraction (EF) and RV outflow tract EF (RVOT EF).<br/>
<b>Results:</b> Seventy-nine patients were included in the analysis; 40 underwent RVIS and 
39 underwent TI repair. None of the patients in the TI repair group had an initial palliation with a systemic to pulmonary arterial shunt compared to seven (18%) in the 
RVIS group (P < .01). There was no appreciable difference in RVEDVi (122 ± 29 cc/
m<sup>2</sup>
 vs 130 ± 29 cc/m<sup>2</sup>
, P = .59) or pulmonary regurgitant fraction (40 ± 13 vs 37 ± 18, 
P = .29) between the RVIS and TI groups. Compared to the TI group, the RVIS group 
had higher RVEF (54 ± 6% vs 44 ± 9%, P < .01), lower RVESV (57 ± 17 cc/m<sup>2</sup>
 vs 
67 ± 25 cc/m<sup>2</sup>
, P = .03), higher LVEF (61 ± 11% vs 54 ± 8%, P < .01), higher RVOT EF 
(47 ± 12% vs 41 ± 11%, P = .03), and higher RV sinus EF (56 ± 5% vs 49 ± 6%, P < .01).<br/>
<b>Conclusions:</b> In this selected cohort, patients who underwent RVIS repair for TOF 
had higher right and left ventricular ejection fraction compared to those who underwent TI repair.},
DOI = {10.1111/chd.12863}
}