Risk factors for morbidity in infants undergoing tetralogy of fallot repair

Abstract

Background:Primary repair of tetralogy of Fallot (TOF) has low surgical mortality, but some patients still experience significant postoperative morbidity.Aim:To review our institutional experience with primary TOF repair, and identify predictors of intensive care unit (ICU) morbidity.Settings and Design:Medium-sized pediatric cardiology program. Retrospective study.Subjects and Methods:We retrospectively reviewed all the patients with TOF and pulmonic stenosis who underwent primary repair in infancy at our institution from January 2001 to December 2012. Preoperative, operative, and postoperative demographic and morphologic data were analyzed. ICU morbidity was defined as prolonged ICU stay (≥7 days), and/or prolonged duration of mechanical ventilation (≥48 h).Statistical Analysis Used:Multiple logistic regression analysis.Results:Ninety-seven patients underwent primary surgical repair during the study period. The median age was 4.9 months (1-9 months) and the median weight was 5.3 kg (3.1-9.8 kg). There was no early surgical mortality. Incidence of junctional ectopic tachycardia (JET) and persistent complete heart block was 2 and 1%, respectively. The median length of ICU stay was 6 days (2-21 days) and median duration of mechanical ventilation was 19 h (0-136 h). By multiple regression analysis, age and weight were independent predictors of length of ICU stay, while surgical era was an independent predictor of duration of mechanical ventilation.Conclusion:Primary TOF repair is a safe procedure with low mortality and morbidity in a medium-sized program with outcomes comparable to national standards. Age and weight at the time of surgery remain significant predictors of morbidity.

Factors affecting perioperative mortality in tetralogy of Fallot

“…5 Mean duration of ICU stay was 6.3±5.1 days in a study by Bakhtiary et al 7 and 6 days (range: 2-21) in a study by Egbe et al 5 In our study it was 7.2 ± 8.6 days (range: 1-49), while median duration of MV was 19 hours (range: 2-744), which is consistent with the data reported in the literature. Our patients under 1 year of age had higher mortality (p<0.05) and, ECMO rate (p<0.01) and stayed longer on MV in the postoperative period as opposed to the patients over 1 year of age.…”

“…centers in developed countries perform successful total correction with no early mortality, [5][6][7] while in developing countries mortality rates are as high as 6.9-15.3%. 8,9 In our study, the early mortality rate after total repair of TOF was 7.3%.…”

“…In their recent study, Egbe et al reported no mortality among patients under 3 months old after repair of TOF. 5 Nevertheless, performing the surgery in patients of a small size and weight may be challenging and have a poor hemodynamic outcome. Pigula et al reported that smaller body surface area and concomitant pulmonary atresia were independent risk factors for high mortality in TOF under 90 days old.…”

“…4 Despite low surgical mortality, however, intensive care unit (ICU) morbidity is still relatively high after primary repair TOF. 5 In developing countries, the morbidity and mortality rates are not yet at a desirably low levels.…”

Mandibular Distraction Osteogenesis in Low-Weight Neonates with Robin Sequence

“…We chose <4 kg as our study population as surgical risk and complexity in other pediatric surgery specialties is associated with children who are low weight at the time of surgery, and the CPT code modifier uses the weight limit of 4 kg. [30][31][32] One of the earliest reports by Denny on the use of MDO for the treatment of RS described 5 successfully treated patients who were under 4 kg at the time of surgery. 5 There are several other reports on MDO for the treatment of RS, however these reports either describe a large patient population 2 or make no specific mention of weight at the time of surgery.…”