Results of elective repair at 6 months or younger in 277 patients with tetralogy of Fallot: A 14-year experience at a single center

Kirsch, Roxanne; Glatz, Andrew C.; Gaynor, J. William; Nicolson, Susan C.; Spray, Thomas L.; Wernovsky, Gil; Bird, Geoffrey L.

doi:10.1016/j.jtcvs.2013.03.033

Cited by 40 publications

(20 citation statements)

References 24 publications

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“…This difference persisted after adjusting for known risk factors for post-operative morbidity and mortality. Moreover, while the PLOS for our total cohort were similar to other reports for patients after repair of conotruncal defects 6, 13 , we found that those with intramural VSDs had a significantly longer PLOS compared to those with a non-intramural VSD or no VSD after surgery. This difference persisted after correcting for potential confounders.…”

Section: Discussionsupporting

confidence: 89%

Intramural Ventricular Septal Defect Is a Distinct Clinical Entity Associated With Postoperative Morbidity in Children After Repair of Conotruncal Anomalies

et al. 2015

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Background Intramural ventricular septal defects (VSDs) are interventricular communications through right ventricular free wall trabeculations that can occur after repair of conotruncal anomalies. We assessed the prevalence of residual intramural VSDs and their effect on postoperative course. Methods and Results Children who underwent biventricular repair of a conotruncal anomaly from 1/1/06 to 6/30/13 and had a post-operative transthoracic echocardiogram were included. Images were reviewed for residual intramural or non-intramural VSDs. The primary outcome was a composite of mortality, extracorporeal membrane oxygenation (ECMO) use, and need for subsequent catheter or surgical VSD closure. The secondary outcome was post-operative hospital length of stay (PLOS). A residual VSD was present in 256 of the 442 subjects (58%), of which 231 (90%) were <2mm in size. Forty-nine (11%) had intramural VSDs and 207 (47%) had non-intramural VSDs. Patients with intramural VSDs were more likely to reach the primary composite outcome compared to those with non-intramural VSDs or no residual VSD (14/49 [29%] vs 15/207 [7%] vs 6/186 [3%], p<0.0001). In addition, those with intramural VSDs had longer PLOS compared to those with non-intramural VSDs or no residual VSD (20 days [IQR 11-42] vs 7 days [5-14] vs 6 [4-11], p=0.0001). These associations remained significant after adjusting for known risk factors for poor outcomes, including residual VSD size and operative complexity. Conclusions Among residual VSDs after repair of conotruncal anomalies, intramural VSDs are uniquely associated with postoperative morbidity, mortality, and longer PLOS. It is important to recognize intramural VSDs in the postoperative period.

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Section: Discussionsupporting

confidence: 89%

Intramural Ventricular Septal Defect Is a Distinct Clinical Entity Associated With Postoperative Morbidity in Children After Repair of Conotruncal Anomalies

et al. 2015

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“…Birth weight has been described as a predictor of outcome after congenital heart surgery, in particular when the weight is less than 2.5 kg . In TOF, studies have shown that low birth weight is associated with length of hospital stay . Lower birth weight may reflect fetal health, placental heath, or a genetic basis .…”

Section: Discussionmentioning

confidence: 99%

“…In this study, neonatal repair was independently associated with longer THD. Other studies have shown that neonatal repair for TOF is associated with increased circulatory support time, length of mechanical ventilation, greater use of postoperative inotropes, longer LOHS, and subsequent reoperations . The neonatal heart might be less “mature” and more vulnerable in the symptomatic neonate with TOF and thus less able to tolerate exposures such as cardiopulmonary bypass and ventriculotomy during surgical repair.…”

Section: Discussionmentioning

confidence: 99%

“…13 In TOF, studies have shown that low birth weight is associated with length of hospital stay. [14][15][16] Lower birth weight may reflect fetal health, placental heath, or a genetic basis. [17][18][19] Our findings indicate that subjects should not be electively delivered early, and future study is needed to seek the basis of low birth weight in TOF.…”

Section: Discussionmentioning

confidence: 99%

“…Other studies have shown that neonatal repair for TOF is associated with increased circulatory support time, length of mechanical ventilation, greater use of postoperative inotropes, longer LOHS, and subsequent reoperations. 15,22,27,29,30 The neonatal heart might be less "mature" and more vulnerable in the symptomatic neonate with TOF and thus less able to tolerate exposures such as cardiopulmonary bypass and ventriculotomy during surgical repair. Neurologic vulnerability of the neonate as compared to infant may also be an important variable in this decision, but a variable that has not been fully addressed.…”

Section: Discussionmentioning

confidence: 99%

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Predictors of Length of Hospital Stay After Complete Repair for Tetralogy of Fallot: A Prospective Cohort Study

Mercer‐Rosa

Elci

DeCost

et al. 2018

JAHA

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BackgroundWe sought to identify patient and surgical factors associated with time to hospital discharge in patients undergoing complete repair for tetralogy of Fallot.Methods and ResultsWe performed a prospective cohort study of patients with tetralogy of Fallot admitted for complete repair between May 1, 2012 and June 2, 2017 at Children's Hospital of Philadelphia with detailed demographic, clinical, and operative characteristics. The primary outcome was time to hospital discharge. Cox proportional hazards models were used to identify patient and operative predictors of time to hospital discharge. We enrolled 151 subjects, 62.8% male, 65.6% non‐Hispanic white, and 9.9% non‐Hispanic black. The median time to hospital discharge was 7 days (interquartile range 4, 12). Five patients died in the hospital, all of whom underwent tetralogy of Fallot repair beyond the neonatal period. Greater birth weight was associated with higher rate of hospital discharge (hazard ratio [HR]=1.35, 95% confidence interval (CI) =1.11, 1.64), while absent pulmonary valve versus pulmonary stenosis (HR=0.27, 95% CI=0.08, 0.91), pulmonary valve atresia versus pulmonary stenosis (HR=0.57, 95% CI=0.33, 0.97), presence of aortopulmonary collaterals (HR=0.44, 95% CI=0.24, 0.84), complete repair performed in the neonatal period (<30 days of life) (HR=0.45, 95% CI=0.27, 0.75), more than 1 cardiopulmonary bypass run (HR=0.33, 95% CI=0.18, 0.61), and longer aortic cross‐clamp time (HR [per 10 minutes]=0.88, 95% CI=0.79, 0.97) were associated with lower rate of hospital discharge.ConclusionsPostoperative hospital stay after complete repair of tetralogy of Fallot is in part determined by patient and operative factors. Some (eg, surgical strategy for the symptomatic neonate) may be modifiable. These results may impact patient counseling, choice of surgical approach, and postoperative care.

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Tetralogy of Fallot

Nelson¹,

Bove²,

Hirsch-Romano³

2020

Pediatric and Congenital Cardiology, Cardiac Surgery and Intensive Care

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Results of elective repair at 6 months or younger in 277 patients with tetralogy of Fallot: A 14-year experience at a single center

Cited by 40 publications

References 24 publications

Intramural Ventricular Septal Defect Is a Distinct Clinical Entity Associated With Postoperative Morbidity in Children After Repair of Conotruncal Anomalies

Intramural Ventricular Septal Defect Is a Distinct Clinical Entity Associated With Postoperative Morbidity in Children After Repair of Conotruncal Anomalies

Predictors of Length of Hospital Stay After Complete Repair for Tetralogy of Fallot: A Prospective Cohort Study

Tetralogy of Fallot

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