Early Outcomes of Total Correction in Tetralogy of Fallot in a Tertiary Care Hospital of Peshawar, Khyber Pakhtunkhwa, Pakistan; A Two-Year Retrospective Study

Shah, Syed Mumtaz Anwar; Rehman, Somaiya; Khan, Mohammad Ahmed; Hayat, Muhammad Khizar; Kundi, Rizwan Amin

doi:10.47144/phj.v53i3.1947

Cited by 1 publication

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“…Patients with a corrected TOF, on the other hand, may experience difficulties later, including heart failure, arrhythmias, severe pulmonary regurgitation, and sudden cardiac death, while the long-term effects of early repair are still unknown [ 22 ]. To reduce the incidence of late acute severe pulmonary regurgitation, many of our patients receiving MPA patch also got pulmonary valve reconstruction using autologous pericardial patch depending on surgeons’ preference.…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Surgical Repair of Tetralogy of Fallot: A Comparison Between the Adult and Pediatric Population

Khan,

Jan,

Ahmed

et al. 2023

Cureus

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IntroductionTetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease. Early detection and timely treatment have provided successful repair of the anomaly in the developed world. However, in the developing world, there is still a burden of uncorrected TOF patients reaching adulthood. The goal of this study is to determine whether there is any difference in postoperative complications between adult and pediatric populations following surgical correction for TOF. MethodsThis study involved all those patients who received primary or secondary surgical repair for TOF in our facility between January 2017 and December 2020. The patients were split according to their age into the pediatric group if they were under 18 years and the adult group if they were 18 years or older. Patients with absent pulmonary valve or pulmonary atresia were not included in this study. Patients with large major aortopulmonary collateral arteries (MAPCA) were also excluded from this study. All patients underwent total correction through a median sternotomy approach. The ventricular septal defect was closed with a Bard knitted fiber patch. The right ventricular outflow tract (RVOT) was augmented by excising muscle bands or fibrous bands in the RVOT. If the annulus was smaller than the 3.5 z score, then a transannular patch was done using an autologous pericardium. The main pulmonary artery was augmented in every surgery using an autologous pericardial patch. All patients were shifted to the ICU on the ventilator and were extubated after fulfillment of the extubation criteria. Postoperative complications measured included re-opening, reintubation, prolonged ventilation (>24 hours), and mortality within the index hospital admission. The clinical data of all patients were prospectively collected and analyzed using the chi-square test and t-test. A p-value of less than or equal to 0.05 was considered significant. ResultsThe total number of patients was 134. This included 83 males (60.1%). A total of 114 patients who were aged below 18 years were included in the pediatric group, and 20 patients aged equal to or more than 18 years were included in the adult group. The mean average perfusion time in minutes in the adult group was 125.8 and in the pediatric group, it was 98.79. Similarly, the mean average of the cross-clamp time was also longer in the adult group at 89.55 minutes versus 69.63 minutes in the pediatric group. Overall, in the adult group, three (15%) patients had postoperative complications, while in the pediatric group, a total of 14 (11.9%) patients had postoperative complications (p = 0.001). However, there was no significant difference in the number of re-openings (8.5% vs. 10%; p = 0.8). The total mortality observed was 16 (11.59%). This included 14 (11.9%) in the pediatric group and two (10%) in the adult group. There was no significant difference between the two groups (p = 0.8). ConclusionsSurgical repair of TOF can be performed in both adult and pediatric populations with acceptable outcomes. The mortality ra...

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Section: Discussionmentioning

confidence: 99%