Tetralogy of Fallot Repair Using the RAA and Autologous Pericardium

Use of the right atrial appendage to reconstruct the pulmonary valve (PV) in patients with tetralogy of Fallot (ToF) requiring a transannular patch has been recently introduced in conjunction with bovine pericardial patch with good short and midterm results. This video presents two ToF repairs using the right atrial appendage and autologous pericardium for right ventricular outflow tract (RVOT) reconstruction.

Both patients were treated with the same technique. First, the right appendage was mobilized and removed and the right atrium was oversewn on the beating heart on cardiopulmonary bypass. The right appendage was then prepared, removing the main trabeculations to obtain the thinnest possible leaflets. It was then opened to create the biggest possible diameter according to the Hegar dilator appropriate for the patient’s weight. The right ventricular outflow tract (RVOT) and the main pulmonary artery (PA) were then opened, the rudimental valve was removed, and the neobicuspid PV was implanted after the closure of the ventricular septal defect and the removal of the RVOT muscular bundles. Finally, the RVOT and the main PA were reconstructed with an autologous pericardial patch.

The authors found that this new surgical strategy of ToF repair involving the construction of a neobicuspid pulmonary valve using the right atrial appendage and autologous pericardium is physiological, safe, and reproducible in their experience, with good short-term results and the possibility of tissue growth in the future.

Reference(s)

Surgical repair of tetralogy of Fallot using autologous right atrial appendages: short- to mid-term results. A. Amirghofran, F. Edraki, M. Edraki, G. Ajami, H. Amoozgar, H. Mohammadi. Eur J Cardiothorac Surg. 2021 Apr 13;59:697-704