Optimal Z-score use in surgical decision-making in pulmonary atresia with intact ventricular septum.
MetadataShow full item record
OBJECTIVES: In the surgical treatment of pulmonary atresia with intact ventricular septum, the size of the tricuspid valve annulus (as measured by z-scores) has emerged as a significant factor in deciding which repair to perform. Various tricuspid valve annulus z-scores are reported as "cutoffs" for successful biventricular repair. We aimed to determine whether the use of different z-score data sets contributed to the gross variation in "cutoffs" for successful biventricular repair reported in the literature. METHODS: A single search was made of PubMed using the "advanced" setting with the following search terms: pulmonary, atresia, intact, septum, z, and score. The filters "title" and "title/abstract" were used for the first four and last two terms, respectively; the instruction "AND" combined all terms. Articles that identified which z-score data set was used in patients with biventricular repairs were included. RESULTS: From 13 articles, 1,392 patients were studied, 410 (29.5%) of which achieved biventricular repair. Three z-score data sets were quoted; mean tricuspid valve annulus z-scores in biventricular repair patients ranged between -0.53 and -5.1. After correcting for discrepancies between z-score data sets, no study reported a mean tricuspid valve annulus z-score <-2.8 in biventricular repair patients and 83.3% reported mean tricuspid valve annuli z-scores >-1.7. CONCLUSION: The use of varied tricuspid valve annuli z-score data sets may have contributed to gross variations in reported "cutoffs" for successful biventricular repair. This could lead to inappropriate surgical pathway allocation.
The following license files are associated with this item: