Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub‐Saharan experience

Tefera, Endale; Gedlu, Etsegenet; Nega, Berhanu; Tadesse, Birkneh Tilahun; Chanie, Yilkal; Dawoud, A al; Moges, Fekadesilassie; Bezabih, Abebe; Moges, Tamirat; Centella, Tomasa; Marianeschi, Stefano; Coca, A.; Collado, Ramón Carreras; Kassa, Mamo Woldu; Johansson, Sören; Doorn, Carin van; Barber, Brent J.; Teodori, Michael F.

doi:10.1111/jocs.14270

Cited by 6 publications

(14 citation statements)

References 25 publications

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“…The study looked retrospectively at 62 children and adolescents who underwent tetralogy of Fallot (TOF) repair. In study, 91.9% underwent primary TOF repair while 6.5% rst underwent initial palliative surgery (19). We note that these studies, which compare with ours were in developing countries.…”

Section: Demographics Pre -Operative Intraoperative Characteristics O...supporting

confidence: 53%

Early Surgical Outcomes of Tetralogy of Fallot Patients Following Primary Intracardiac Repair at Uganda Heart Institute

Khainza,

Oketcho,

Aliku

et al. 2024

Preprint

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Background Tetralogy of Fallot (TOF) is the commonest form of cyanotic congenital heart disease (CHD) worldwide and accounts for 7% of CHD in Uganda. Without surgery, the natural history is nearly always fatal in the long term. Surgery is recommended in infancy to avoid complications of chronic cyanosis and right sided heart failure. In developing countries like Uganda, surgery is usually delayed due several challenges. Objective This study was to determine the early surgical outcomes of TOF patients following primary intracardiac repair at Uganda Heart Institute (UHI) and identify factors associated with these surgical outcomes. Methodology This was a retrospective chart review of primary TOF repair patients at UHI between February 2012 and October 2022. The patient’s outcomes were reviewed from the time of surgery until 30 days in the post operative period. Results A total of 104 patients underwent primary TOF repair at UHI, records of 88 patients (84.6%) were available for review. Males accounted for 48.9% (n=43) of the cases. The median age at the time of operation was 4 years (interquartile range 5.46 years), age range of 9 months to 16years. Children with phenotypic syndromes accounted for 5.7% (n=5), 2 with Down’s and 2 Noonan’s syndromes, followed by 1with Di George syndrome. Early post operative outcomes included residual ventricular septal defects (VSDs) 39.8% (35/88), right ventricular (RV) dysfunction 37.5% (33/88), residual pulmonary regurgitation 30.7% (27/88), residual right ventricular outflow tract obstruction (RVOTO) 30.0% (27/88), pleural effusion 27.3% (24/88), arrhythmias 27.3% (24/88), left ventricular (LV) systolic dysfunction 10.2% (9/88). Overall, 7 children (8%) died in the first 30 days and were all operated on after the age of one year. At multivariate analysis mortality was associated significantly with prolonged mechanical ventilation time post procedure. Conclusion The commonest post operative outcomes were residual ventricular septal defects and RV failure. Our 30-day mortality following TOF repair was 8 %. Prolonged mechanical ventilation time was associated with mortality in this study.

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Section: Demographics Pre -Operative Intraoperative Characteristics O...supporting

confidence: 53%

Early Surgical Outcomes of Tetralogy of Fallot Patients Following Primary Intracardiac Repair at Uganda Heart Institute

Khainza,

Oketcho,

Aliku

et al. 2024

Preprint

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“…Survival papers mainly looked at survival of babies with CA admitted for surgical care (e.g., [ 19 , 28 , 54 , 66 , 76 , 89 ]). The period of survival was mainly during the first year of life, or in the days/months following surgery, with no long-term survival studies.…”

Section: Resultsmentioning

confidence: 99%

“…For the 11 papers identified for this category, the focus was upon cost of care in relation to financial challenges influencing access to care and poor outcomes (e.g., [ 25 , 31 , 89 , 236 ]), alongside social challenges [ 31 , 175 ]. Papers on cost of care primarily focused on CHD (45.5%) and OFC (27.3%), relating to the financial burden of individuals accessing care (and the impact on care seeking) rather than the cost to the health system.…”

Section: Resultsmentioning

confidence: 99%

“…Papers focused on different issues, including challenges faced by patients in accessing surgical care e.g. [ 25 , 35 , 37 ] (including due to COVID-19, [ 57 ]); and performing surgery for complex anomalies [ 37 , 38 ]; the quality of peri- and/or post-operative surgical care (e.g., [ 32 , 33 ]); outcome/survival after surgery (e.g., [ 19 , 89 , 120 ]); and developing cost-effective, local surgical management tools (e.g. management silos for gastroschisis [ 58 ]).…”

Section: Resultsmentioning

confidence: 99%

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The burden, prevention and care of infants and children with congenital anomalies in sub-Saharan Africa: A scoping review

Leke,

Malherbe,

Kalk

et al. 2023

PLOS Glob Public Health

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The aim of this scoping review was to determine the scope, objectives and methodology of contemporary published research on congenital anomalies (CAs) in sub-Saharan Africa (SSA), to inform activities of the newly established sub-Saharan African Congenital Anomaly Network (sSCAN). MEDLINE was searched for CA-related articles published between January 2016 and June 2021. Articles were classified into four main areas (public health burden, surveillance, prevention, care) and their objectives and methodologies summarized. Of the 532 articles identified, 255 were included. The articles originated from 22 of the 49 SSA countries, with four countries contributing 60% of the articles: Nigeria (22.0%), Ethiopia (14.1%), Uganda (11.7%) and South Africa (11.7%). Only 5.5% of studies involved multiple countries within the region. Most articles included CA as their primary focus (85%), investigated a single CA (88%), focused on CA burden (56.9%) and care (54.1%), with less coverage of surveillance (3.5%) and prevention (13.3%). The most common study designs were case studies/case series (26.6%), followed by cross-sectional surveys (17.6%), retrospective record reviews (17.3%), and cohort studies (17.2%). Studies were mainly derived from single hospitals (60.4%), with only 9% being population-based studies. Most data were obtained from retrospective review of clinical records (56.1%) or via caregiver interviews (34.9%). Few papers included stillbirths (7.5%), prenatally diagnosed CAs (3.5%) or terminations of pregnancy for CA (2.4%).This first-of-a-kind-scoping review on CA in SSA demonstrated an increasing level of awareness and recognition among researchers in SSA of the contribution of CAs to under-5 mortality and morbidity in the region. The review also highlighted the need to address diagnosis, prevention, surveillance and care to meet Sustainable Development Goals 3.2 and 3.8. The SSA sub-region faces unique challenges, including fragmentation of efforts that we hope to surmount through sSCAN via a multidisciplinary and multi-stakeholder approach.

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“…This patient belonged to the transannular patch group, had a loss of atrioventricular synchrony with tachycardia, and was refractory to Amiodarone therapy. Most of the evidence in the literature pointed out the benefits of timely repair of any significant pulmonary or tricuspid valve dysfunction [ 17 - 18 ] .…”

Section: Discussionmentioning

confidence: 99%

Intracardiac Repair in Late Adolescent and Adult Tetralogy of Fallot — Early and Midterm Results from a Tertiary Care Centre

Bhushan¹,

Chugh²,

Loona³

et al. 2022

Braz J Cardiovasc Surg

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Introduction In developing countries like India, it is common for late presentation of Tetralogy of Fallot (TOF) patients to a hospital as compared to that of developed countries. The objective of this study is to analyze the surgical outcome of TOF patients with age > 15 years. Methods This is a retrospective descriptive study of the surgical outcomes of 45 adult patients undergoing correction for TOF. Epidemiology, symptomology, and preoperative evaluation were performed. Results Most of the patients were male (33 [73%]). The median age was 21 years. A total of 42 (93.33%) patients had subaortic ventricular septal defect (VSD), while three (6.6%) patients presented with doubly committed VSD. The most common type of right ventricular outflow tract (RVOT) obstruction was combined infundibular and valvular types, accounting for 34 cases (75.5%). Six patients had infundibular RVOT obstruction, while three patients (6.6%) had predominantly valvular pulmonary stenosis. We performed trans-right atrial repair in 33 patients. Right atrium-pulmonary artery approach was used in five patients (11.1%). The most common postoperative complication was right bundle branch block, seen in 14 patients, with a mortality rate of 2% in the early postoperative period. We achieved excellent early and midterm survival results and significant improvement in functions and disease-free quality of life. Conclusion Intracardiac repair in adult TOF can be performed with low mortality, less residual RVOT obstruction, and need for revision of RVOT far less frequent by using the Jhajhria Infundibular Resection Adequacy Assessment technique (JIRAAT) to assess for adequacy of infundibular resection.

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Factors associated with perioperative mortality in children and adolescents operated for tetralogy of Fallot: A sub‐Saharan experience

Cited by 6 publications

References 25 publications

Early Surgical Outcomes of Tetralogy of Fallot Patients Following Primary Intracardiac Repair at Uganda Heart Institute

Early Surgical Outcomes of Tetralogy of Fallot Patients Following Primary Intracardiac Repair at Uganda Heart Institute

The burden, prevention and care of infants and children with congenital anomalies in sub-Saharan Africa: A scoping review

Intracardiac Repair in Late Adolescent and Adult Tetralogy of Fallot — Early and Midterm Results from a Tertiary Care Centre

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