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Relation Between Pulmonary Artery Pressures Measured Intraoperatively and at One-Year Catheterization After Unifocalization and Repair of Tetralogy With Major Aortopulmonary Collateral Arteries

  • Michael Ma
    Correspondence
    Address reprint requests to Michael Ma, MD, Lucile Packard Children's Hospital, Stanford University School of Medicine, Falk Cardiovascular Research Center, 870 Quarry Rd, Stanford, CA 94305.
    Affiliations
    Departments of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Standford, California.
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  • Lynn F Peng
    Affiliations
    Departments of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Standford, California.
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  • Yulin Zhang
    Affiliations
    Departments of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Standford, California.
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  • Lisa Wise-Faberowski
    Affiliations
    Departments of Anesthesia, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Standford, California.
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  • Elisabeth Martin
    Affiliations
    Departments of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Standford, California.
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  • Frank L. Hanley
    Affiliations
    Departments of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Standford, California.
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  • Doff B. McElhinney
    Affiliations
    Departments of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Standford, California.
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Published:January 26, 2022DOI:https://doi.org/10.1053/j.semtcvs.2022.01.004
      To assess the relationships between pulmonary artery (PA) pressure and the PA: aortic systolic pressure ratio measured intraoperatively and at surveillance catheterization in patients achieving complete unifocalization and repair for tetralogy of Fallot with major aortopulmonary collateral arteries (TOF/MAPCAs). This was a single-center retrospective cohort analysis of all patients who underwent complete repair of TOF/MAPCAs from 2002 to 2019 and received a postoperative surveillance catheterization at our center 6-24 months after surgery. Associations between intraoperative and catheter hemodynamic data were analyzed. A total of 163 patients were included. Median systolic PA pressure was 30 (quartiles 26, 35) and 35 (28, 42) mm Hg intraoperatively and at catheterization respectively; systolic aortic pressure 90 (86, 100) and 84 (76, 92); and PA:aortic pressure ratio was 0.33 (0.28, 0.40) and 0.41 (0.34, 0.49). Moderate correlation was found between the intraoperative and catheter-based hemodynamics, with the majority of systolic PA pressures within 10 mm Hg and PA:Ao systolic ratios within 0.1. Changes in the ratio were influenced to a similar degree by differences in PA and aortic pressures. Surgical and/or catheter reinterventions were more common in patients with both higher intraoperative PA systolic pressure and PA:aortic systolic ratios and in those with a greater discrepancy between intraoperative and catheterization values. PA systolic pressure and the PA:aortic systolic pressure ratio measured immediately after repair remains useful metrics for assessing the initial operative PA reconstruction, and as indicators of longer-term hemodynamics. Initially elevated and subsequently discrepant PA systolic pressure and PA:aortic systolic pressure ratios were associated with higher rates of reintervention.

      Graphical abstract

      Key Words

      Abbreviations:

      Ao (Aorta), CR (complete repair), LPCH (Lucile Packard Children's Hospital), MAPCAs (major aortopulmonary collateral arteries), PA (pulmonary artery), RV (right ventricle), TOF (Tetralogy of Fallot)
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      Linked Article

      • Commentary: Monofocal or Multifocal Pressure Measurements in a Unifocal?
        Seminars in Thoracic and Cardiovascular SurgeryVol. 34Issue 3
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          Ma and colleagues present a retrospective analysis comparing intraoperative pulmonary artery (PA) pressure following unifocalization for Tetralogy with major aortopulmonary collateral arteries and follow-up hemodynamic catheterization, to describe the natural history of PA pressures postoperatively.1 The purpose was to validate intraoperative measurement of central PA pressure and ratio of systemic pressure as metrics for assessing the hemodynamic result after complete repair. These results verify both are congruent metrics to indicate the quality of the repair (unifocalization) and prognosticate postoperative success and need for re-intervention.
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