Complete Repair of Tetralogy of Fallot in the Neonate

Hirsch, Jennifer C.; Mosca, Ralph S.; Bove, Edward L.

doi:10.1097/00000658-200010000-00006

Cited by 192 publications

(121 citation statements)

References 16 publications

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“…In large pediatric cardiac centers in North America, however, postoperative mortality after complete repair of many congenital heart defects in neonates is currently Ͻ5%. [17][18][19][20] Therefore, if a general neonatal cardiac surgery population is studied, enrolling sufficient patients to achieve adequate statistical power using mortality as the primary efficacy end point will be problematic, even in multicenter studies. In contrast, early mortality after initial palliation of the complex single ventricle lesion hypoplastic left heart syndrome using the modified Norwood procedure is ϳ10% to 15% in larger centers that are experienced with this procedure.…”

Section: Study-design Issuesmentioning

confidence: 99%

Summary Proceedings From the Cardiology Group on Postoperative Cardiac Dysfunction

2006

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As many as one third of the 35 000 to 40 000 infants born in the United States each year with significant congenital heart defects require surgery before the first year of life. Intraoperative support techniques, including cardiopulmonary bypass, can precipitate a complex, systemic inflammatory response that impairs the function of multiple organs and results in more hemodynamic instability and early morbidity in newborns than in older infants and children. Vasoactive agents are routinely used in the postoperative management of these patients either to treat or prevent hemodynamic instability and low cardiac output. However, the effectiveness of vasoactive agents used either individually or in combination in achieving specific therapeutic goals such as maintenance of a minimum cardiac index or arteriovenous oxygen saturation difference has not been systematically evaluated in preterm and term neonates. In addition, there are insufficient safety data for these agents in preterm and term neonates, both as individual agents and in combination. This article proposes a framework for developing prospective clinical studies to determine the efficacy of different vasoactive agents to promote adequate cardiac output and hemodynamic stability after neonatal cardiac surgery. The framework provides an overview of the issues relevant to the design of prospective clinical studies of vasoactive agents in the newborn patient population undergoing cardiac surgery. The issues identified by the cardiology group illustrate the difficulty of designing and executing clinical trials in vulnerable pediatric populations with limited numbers of patients, especially when standard practice is widely believed to be beneficial despite the lack of rigorous data to support such practice.www.pediatrics.org/cgi

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Section: Study-design Issuesmentioning

confidence: 99%

Summary Proceedings From the Cardiology Group on Postoperative Cardiac Dysfunction

2006

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“…Currently, corrective surgery is typically performed in the first year of life. 39 With good surgical results, survival and quality of life have been excellent. In a retrospective analysis from the Mayo Clinic, 86% of patients were alive at 32 years, 40 and in a series of 151 patients from Toronto, Canada, 41 94% were in New York Heart Association functional class I.…”

Section: "Natural History" After Surgical Intervention For Tetralogymentioning

confidence: 99%

Pathophysiology of Congenital Heart Disease in the Adult

2008

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“…Kirklin et al and Katz et al reported that the mortality risk was increased by 2.5 and the re-operation risk was increased by 7.3-fold when RV/LV pressure ratio is > 0.85 [11,20]. Hirch et al also reported that the re-operation risk is increased when the RV/LV pressure ratio is > 0.7 [21]. In the present study, we aimed to keep the RV/LV pressure ratio < 0.7 in both treatment groups.…”

Section: Discussionmentioning

confidence: 98%

Congenital heart disease in children and adults Comparison of the Mid-term Results of Pulmonary Valve-sparing Strategy and Transannular Patch Repair in Tetralogy of Fallot

Arslan¹,

Adademir²,

Elibol³

et al. 2013

kitp

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StreszczenieWprowadzenie: Pomiędzy styczniem 2006 roku a październi-kiem 2009 roku 148 pacjentów zostało poddanych całkowitej korekcji tetralogii Fallota (TOF). U 13 pacjentów przed całkowitą korekcją przeprowadzono zabiegi paliatywne, natomiast u pozostałych 135 pacjentów całkowita korekcja była pierwszym i definitywnym zabiegiem. Materiał i metody: Pacjenci po zabiegu całkowitej korekcji tetralogii Fallota zostali poddani retrospektywnej ewaluacji. Przypisano ich do jednej z dwóch grup, w zależności od tego, czy zastosowano u nich łatę przezpierścieniową (transannular patch -TAP), czy strategie oszczędzające zastawkę pnia płucnego (pulmonary valve-sparing -PVS). Grupy porównano w zakresie wieku, wagi, płci, struktury pierścieni, śródoperacyjnego stosunku ciśnienia prawej komory do ciśnienia lewej komory (RV/LV) oraz resztkowego gradientu skurczowego RVOT, rozkurczowej grubości ściany prawej komory w osi przymostkowej długiej, związanej z wiekiem dylatacji, śmiertelności i zachorowalności w czasie obserwacji. Wyniki: Liczba pacjentów z (zależną od wieku) rozkurczową dylatacją prawej komory była znacząco większa w grupie TAP (88,9%) niż w grupie PVS (4,8%; p = 0,0009). Średnio odległe wyniki stosowania strategii oszczędzającej zastawkę pnia płuc-nego były znacząco lepsze od wyników stosowania łat przezpierścieniowych w zakresie ochrony funkcji prawej komory. Wnioski: Aby chronić funkcję zastawki pnia płucnego, należy w miarę możliwości unikać korekcji TAP. Strategia oszczędzająca zastawkę pnia płucnego wydaje się skutkować mniejszą około-operacyjną i odległą zachorowalnością oraz zapewniać lepszą długoterminową ochronę funkcji prawej komory w porównaniu z korekcją TAP. Słowa kluczowe: tetralogia Fallota, przezpierścieniowy. CONGENITAL HEART DISEASE IN CHILDREN AND ADULTS AbstractBackground: Between January 2006 and October 2009, 148 patients underwent total repair of tetralogy of Fallot (TOF). In 13 patients, palliative procedures were performed before total repair, while total correction was the initial and definitive procedure in 135 patients. Materials and methods: Patients who underwent total repair of TOF were evaluated retrospectively. They were assigned to one of two groups based on the right ventricular outflow tract (RVOT) reconstruction technique used: the transannular patch (TAP) group or the pulmonary valve-sparing strategy group. The two groups were compared with regard to age, weight, gender, annular structure, intraoperative right ventricular to left ventricular (RV/LV) pressure ratio, residual RVOT systolic gradient, RV diastolic parasternal long axis wall thickness, agespecific dilation, mortality, and morbidity during follow-up. Results: The percentage of patients with RV diastolic dilation (age specific) was significantly higher in the TAP group (88.9%) than in the pulmonary valve-sparing group (4.8%; p = 0.0009). The mid-term results of the pulmonary valve-sparing strategy were significantly superior to TAP repair in terms of preservation of right ventricular function. Conclusion: In order to...

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Complete Repair of Tetralogy of Fallot in the Neonate

Cited by 192 publications

References 16 publications

Summary Proceedings From the Cardiology Group on Postoperative Cardiac Dysfunction

Summary Proceedings From the Cardiology Group on Postoperative Cardiac Dysfunction

Pathophysiology of Congenital Heart Disease in the Adult

Congenital heart disease in children and adults Comparison of the Mid-term Results of Pulmonary Valve-sparing Strategy and Transannular Patch Repair in Tetralogy of Fallot

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Complete Repair of Tetralogy of Fallot in the Neonate

Cited by 192 publications

References 16 publications

Summary Proceedings From the Cardiology Group on Postoperative Cardiac Dysfunction

Summary Proceedings From the Cardiology Group on Postoperative Cardiac Dysfunction

Pathophysiology of Congenital Heart Disease in the Adult

﻿﻿Congenital heart disease in children and adults Comparison of the Mid-term Results of Pulmonary Valve-sparing Strategy and Transannular Patch Repair in Tetralogy of Fallot

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Congenital heart disease in children and adults Comparison of the Mid-term Results of Pulmonary Valve-sparing Strategy and Transannular Patch Repair in Tetralogy of Fallot