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

Authors

  • Pribadi Wiranda Busro Department of Pediatric and Congenital Heart Surgery, National Cardiovascular Center Harapan Kita/Division of Thoracic, Cardiac, and Vascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Ahmad Adityawarman Division of Thoracic, Cardiac, and Vascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Suprayitno Wardoyo Division of Thoracic, Cardiac, and Vascular Surgery, Department of Surgery, Faculty of Medicine, Universitas Indonesia, Jakarta, Indonesia
  • Olfi Lelya Pediatric Cardiology and Congenital Heart Disease Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia
  • Oktavia Lilyasari Pediatric Cardiology and Congenital Heart Disease Division, Department of Cardiology and Vascular Medicine, Faculty of Medicine Universitas Indonesia

DOI:

https://doi.org/10.30701/ijc.2140

Keywords:

Pulmonary valve annulus diameter z-score, Tetralogy of Fallot, Transannular patch, Cardiac surgery

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.

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References

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Published

2026-10-25

How to Cite

Busro, P. W., Adityawarman, A., Wardoyo, S., Lelya, O., & Lilyasari, O. (2026). 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. Indonesian Journal of Cardiology. https://doi.org/10.30701/ijc.2140

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Online First

Section

Clinical Research

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