Repair of Tetralogy of Fallot in Children Less Than 4 kg Body Weight

Abstract

We reviewed our experience of surgical repair of Tetralogy of Fallot (TOF) in children weighing less than or equal to 4 kg to compare outcome of early palliation versus complete repair as the initial surgical approach. Seventy-six patients, weighing ≤ 4 kg, with TOF surgery between January 2005 and September 2013 were included in this single-center retrospective study. Twenty-five patients who underwent initial shunt procedure followed by later full repair were compared to 51 patients who had primary full repair for differences in baseline characteristics and outcomes. Shunt group patients had lower body weight, 2.76 ± 0.69 versus 3.11 ± 0.65 (kg), p = 0.03, and lower preoperative oxygen saturations, 82 ± 7 versus 90 ± 6 (%), p = 0.0001, than full repair group. A higher number of surgical procedures per patient was recorded in shunt patients, 2.29 ± 0.59 versus 1.27 ± 0.49, p = 0.00002. Thirteen of 51 patients in the full repair group required a repeat surgery. Catheterization procedures were performed in 12 patients in shunt and in 15 patients in full repair group, with interventional angioplasty in three and 11, respectively, p ≥ 0.05. Two patients, both in the shunt group, died after the surgery. Early full repair had longer hospital stay but significantly less hospitalizations 1.95 ± 1.3 versus 2.5 ± 1.4, p = 0.03. Initial complete repair of TOF in small children yielded favorable outcome with significantly less surgical procedures and subsequent hospitalizations. Cath laboratory re-interventions for residual defects were similar after both surgical approaches, and type of initial surgery does not predict freedom from re-intervention.

Computational Pre-surgical Planning of Arterial Patch Reconstruction: Parametric Limits and In Vitro Validation

“… 17 , 18 In mild cases of the PA stenosis, to avoid surgical intervention, one treatment strategy could be the use of cardiac catheterization with balloon angioplasty, occasionally with an arterial stent. 14 , 28 , 34 Indeed, for mild stenosis levels, our simulations support the catheterization approach since post-operative stenosis recovery level is not high for the standard patch surgery. On the other hand, surgical intervention is preferred if the percentage of the PA stenosis is more than 50%, essentially the post-op improvement limit as shown in this paper.…”

“…In mild cases of the PA stenosis, to avoid surgical intervention, one treatment strategy could be the use of cardiac catheterization with balloon angioplasty, occasionally with an arterial stent 14,28,34. Indeed, for mild stenosis levels, our simulations support the catheterization approach since post-operative stenosis recovery level is not high for the standard patch surgery.…”

Determinants of Adverse Outcomes After Systemic-To-Pulmonary Shunts in Biventricular Circulation

“…Morbidity rates remain high (9% to 18%) [3,7], with shunt thrombosis continually observed in 3% to 12% of cases [8][9][10][11][12]. Despite these pitfalls, use of shunts remains crucial in many single ventricle palliation strategies and complex biventricular lesions to allow for patients and their pulmonary vasculature to grow to optimal size for repair [2,[13][14][15]. Some teams, like ours, still favor a strategy of early shunting for lesions that may be treated later by complete repair such as tetralogy of Fallot (TOF) [16,17].…”

Late complete heart block post-tetralogy of Fallot repair: a possible new predicting, precipitating factor and review of related cases

“…Gerrah et al compared interventions in children weighing less than or equal to 4 kg in a retrospective study. They found that initial complete repair of TOF was associated with significantly less hospitalisation compared with the partial repair 67.…”