Influence of staged repair and primary repair on outcomes in patients with complete atrioventricular septal defect and tetralogy of Fallot: a systematic review and meta-analysis

Ленько, Е. В.; Kulyabin, Yu.Yu.; Zubritskiy, Alexey; Gorbatykh, Yu. N.; Naberukhin, Yuriy; Nichay, N.R.; Bogachev-Prokophiev, Alexander; Karaskov, Alexander

doi:10.1093/icvts/ivx267

Cited by 6 publications

(1 citation statement)

References 14 publications

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“…However, palliative shunt procedures are associated with a 3% to 5% early mortality rate 38, 39 . The superiority of a staged approach versus primary neonatal repair has not been demonstrated 40, 41 .…”

Section: Variations In Current Treatment Strategiesmentioning

confidence: 99%

Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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Tetralogy of Fallot (ToF) is the most common type of cyanotic congenital heart disease. Since the first surgical repair in 1954, treatment has continuously improved. The treatment strategies currently used in the treatment of ToF result in excellent long-term survival (30 year survival ranges from 68.5% to 90.5%). However, residual problems such as right ventricular outflow tract obstruction, pulmonary regurgitation, and (ventricular) arrhythmia are common and often require re-interventions. Right ventricular dysfunction can be seen following longstanding pulmonary regurgitation and/or stenosis. Performing pulmonary valve replacement or relief of pulmonary stenosis before irreversible right ventricular dysfunction occurs is important, but determining the optimal timing of pulmonary valve replacement is challenging for several reasons. The biological mechanisms underlying dysfunction of the right ventricle as seen in longstanding pulmonary regurgitation are poorly understood. Different methods of assessing the right ventricle are used to predict impending dysfunction. The atrioventricular, ventriculo-arterial and interventricular interactions of the right ventricle play an important role in right ventricle performance, but are not fully elucidated. In this review we present a brief overview of the history of ToF, describe the treatment strategies currently used, and outline the long-term survival, residual lesions, and re-interventions following repair. We discuss important remaining challenges and present the current state of the art regarding these challenges.

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Section: Variations In Current Treatment Strategiesmentioning

confidence: 99%

Current outcomes and treatment of tetralogy of Fallot

et al. 2019

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Atrioventricular Septal Defects

Backer

Mavroudis

2023

Pediatric Cardiac Surgery

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Association of tetralogy of Fallot and complete atrioventricular canal: a single-centre 40-year experience

Fernandez-Cisneros,

Staffa,

Emani

et al. 2024

European Journal of Cardio-Thoracic Surgery

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OBJECTIVES Outcome data in tetralogy of Fallot (ToF) and complete atrioventricular canal (CAVC) are limited. We report our experience for over 40 years in this patient population. METHODS Single center, retrospective analysis of patients who underwent surgical repair with diagnosis of ToF-CAVC from 1979 to 2022, divided in two different periods and compared. RESULTS A total of 116 patients were included: 1979–2007 (n = 61) and 2008–2021 (n = 55). Balanced CAVC (80%) and Rastelli type C CAVC (81%) were most common. Patients in the later era were younger (4 vs 14 months, p < 0.001), fewer had trisomy 21 (60% vs 80%, p = 0.019) and fewer had prior palliative prior procedures (31% vs 43%, p < 0.001). In the earlier era, single-patch technique was more common (62% vs 16%, p < 0.001) and in recent era double-patch technique was more common (84% vs 33%, p < 0.001). In the earlier era right ventricular outflow tract was most commonly reconstructed with transannular patch (51%) while in more recent era valve-sparing repairs were more common (69%) (p < 0.001). In-hospital mortality was 4.3%. Median follow-up was 217 and 74 months for the first and second eras. Survival for earlier and later eras at 2-, 5- and 10-years follow-up was (85.1%, 81.5%, 79.6% vs 94.2%, 94.2%, 94.2% respectively, log-rank test p = 0.03). CONCLUSIONS The surgical approach to ToF-CAVC has evolved over time. More recently, patients tended to receive primary repair at younger ages and had fewer palliative procedures. Improved surgical techniques allowing for earlier and complete repair has shown a decrease in mortality, more valve sparing procedures without an increase in total re-operations.

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Influence of staged repair and primary repair on outcomes in patients with complete atrioventricular septal defect and tetralogy of Fallot: a systematic review and meta-analysis

Cited by 6 publications

References 14 publications

Current outcomes and treatment of tetralogy of Fallot

Current outcomes and treatment of tetralogy of Fallot

Atrioventricular Septal Defects

Association of tetralogy of Fallot and complete atrioventricular canal: a single-centre 40-year experience

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