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Pulmonary Valve Annulus Z-Score as a Predictor of Transannular Patch Insertion in Tetralogy of Fallot Repair: A Cross-sectional Study at National Cardiovascular Center Harapan Kita

Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: The use of a Transannular Patch (TAP) in the surgical repair of Tetralogy of Fallot (TOF) can improve Right Ventricular Outflow Tract (RVOT) flow but may increase the risk of long-term pulmonary insufficiency. Therefore, the decision to use TAP is critical. The Pulmonary Valve Annulus (PVA) diameter z-score is commonly used to predict TAP insertion; however, no z-score threshold has been established in Indonesia. This study sought to investigate whether the preoperative z-score of PVA diameter predicts the use of TAP during TOF repair surgery. Methods: This cross-sectional study utilized data from 101 TOF patients who underwent TOF repair at National Cardiovascular Center Harapan Kita between January 2023 and December 2024. Patients were divided into two groups based on TAP usage (Yes: n = 65; No: n = 36). Preoperative PVA diameter was obtained from cardiac Multislice Computed Tomography (MSCT). Multivariate logistic regression was performed, and Receiver Operating Characteristic (ROC) curve analyses were conducted to determine the optimal cutoff thresholds. Results: Multivariate analysis showed the z-score of PVA minimal diameter was significantly associated with TAP usage (Odds Ratio [OR] 0.450, 95% Confidence Interval [CI] 0.297 to 0.683, P < 0.001). A preoperative minimum PVA diameter z-score cut-off of -1.6 yielded a sensitivity of 75.4% and a specificity of 61.1%. Conclusions: The z-score of the PVA diameter may serve as a useful predictor in planning an appropriate surgical strategy in ToF repair, particularly regarding the decision to use a TAP.
DOI: 10.30701/ijc.2140
Language: English
Field: Medicine
Open Access status: diamond
OpenAlex ID: W7223550989
FWCI:
Cites: 15
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Related to: 10