Do the Age of Patients with Tetralogy of Fallot at the Time of Surgery and the Applied Surgical Technique Influence the Reoperation Rate?

Abstract

Early repair of TOF within the 1st year of life can be recommended, because mortality is lower than in patients treated at a higher age. There seems no significant difference in the reintervention rate between patients treated within the 1st year of life or later.

Racial/ethnic disparities in timing of death during childhood among children with congenital heart defects

“…Although some of the published literature posits limitation of access to adequate health care as a potential explanation for racial/ethnic differences in adult and infant mortality (Blustein and Weitzman, ; Peterson et al, ; Kressin and Petersen, ; Morales et al, ; Howell, ), the extent to which access to healthcare explain our findings is unclear because increased risk of mortality was only observed for specific CHD phenotypes during certain time periods in early childhood. Access to health care is often associated with social class (Chang et al, ; Gonzalez et al, ), place of residence (Milazzo et al, ; Gonzalez et al, ), age at operation (Perlstein et al, ; Gerling et al, ), type of hospital (Lasa et al, ), hospital volume, and surgical case volume (Perlstein et al, ). Racial/ethnic differences in access to pediatric care and treatment received when care is obtained are well documented (Furth et al, ; Ronsaville and Hakim, ; Flores et al, ).…”

“…Infants with CHDs have increased risk of morbidity and mortality (Lee et al, ; Cleves et al, ; Hoffman, ; Yang et al, ; Lloyd‐Jones et al, 2010) throughout life but especially during infancy and childhood (Nembhard et al, ; Gilboa et al, ; Khairy et al, ). Risk factors associated with increased risk of mortality include preterm birth, low birth weight (Curzon et al, ), number and type of co‐occurring birth defects (Fixler et al, ), CHD phenotype, age at operation (Gerling et al, ), infant sex (Seifert et al, ), type of surgical procedure and more recently, race/ethnicity (Cleves et al, ; Garne, ; Hoffman, ; Chang et al, ; Nembhard et al, ; Nembhard et al, ). Disparities in survival among persons with CHD by maternal race/ethnicity are present overall and for specific CHD phenotypes (Boneva et al, ; Lee et al, ; Nembhard et al, ; Fixler et al, ; Flores, ; Gilboa et al, ; Nembhard et al, ).…”

Current outcomes and treatment of tetralogy of Fallot

“…Other techniques to preserve or replace pulmonary valve competence include pulmonary valvuloplasty with patching limited to the infundibulum 23, 24 , implantation of a monocusp valve 25, 26 , a valved RV-to-PA conduit 27, 28 , or a homograft valve 27 . A survival benefit of these valve-sparing or valve-replacing techniques has not yet been demonstrated 29– 32 .…”

Mortality among infants with birth defects: Joint effects of size at birth, gestational age, and maternal race/ethnicity

“…Yang et al (2006) reported higher rates of mortality for Hispanic infants with central nervous system defects compared to NH-whites, and several studies report that NHblack infants with birth defects had the highest infant and childhood mortality rates compared to NH-whites (Druschel et al, 1996b;Malcoe et al, 1999;Wong and Paulozzi, 2001;Berger et al, 2003;Siffel et al, 2003;Yang et al, 2006) but the differences in mortality disappeared after adjusting for maternal age and education, infant birth weight and sex, and the number of affected organ systems (Druschel et al, 1996b;Berger et al, 2003). In our study, however, Hispanic SGA preterm infants had the highest childhood mortality rate; and racial/ethnic differences for NH-black and Hispanics persisted even after adjustment for covariates.Childhood survival is influenced by several medical and nonmedical factors (Chang et al, 2000) including the types and severity of the defects (Malcoe et al, 1999;Wong and Paulozzi, 2001;Oakeshott and Hunt, 2003;Oakeshott et al, 2007), number of defects (Malcoe et al, 1999; Agha et al, 2006), age at surgical repair (if defect is operable) (Perlstein et al, 1997;Gerling et al, 2009), residence in an urban or rural area (Perlstein et al, 1997), as well as socioeconomic and cultural factors (Chang et al, 2000;Gonzalez et al, 2003). Some of the racial/ethnic variation in risk of death among children with birth defects that we observed may be due to racial/ethnic variation in birth prevalence for particular types of defects.…”