The influence of perioperative factors on outcomes in children aged less than 18 months after repair of tetralogy of Fallot

Dongen, Elisabeth I van; Glansdorp, Angelique G; Mildner, Reinout J; McCrindle, Brian W.; Sakopoulos, Andreas G.; VanArsdell, Glen; Williams, William G.; Bohn, Desmond

doi:10.1016/s0022-5223(03)00035-7

Cited by 58 publications

(54 citation statements)

References 24 publications

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“…We identified age and weight as independent predictors of the length of ICU stay. Our finding is in agreement with the findings of van Dongen et al [13] and van Arsdell et al [20] who also identified younger age at time of TOF repair as an independent predictor of prolonged ICU stay, prolonged duration of mechanical ventilation, and prolonged inotropic support.…”

Section: Discussionsupporting

confidence: 94%

“…In spite of low surgical mortality, ICU morbidity is relatively common after primary TOF repair [13]. There is a strong correlation between ICU morbidity and intraoperative factors such as cardiopulmonary bypass (CPB) time, cross clamp, and surgical techniques [3,11,13].…”

Section: Introductionmentioning

confidence: 99%

“…There is a strong correlation between ICU morbidity and intraoperative factors such as cardiopulmonary bypass (CPB) time, cross clamp, and surgical techniques [3,11,13]. However, our ability to identify patients at risk for significant ICU morbidity based on their preoperative characteristics is limited because of conflicting evidence in the literature [4,5,11,13]. We have hypothesized that certain preoperative demographic and morphologic characteristics increase the risk of ICU morbidity after primary TOF repair.…”

Section: Introductionmentioning

confidence: 99%

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Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot

Egbe

Nguyen

Mittnacht

et al. 2014

Korean J Thorac Cardiovasc Surg

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BackgroundOur objectives were to review our institutional early and midterm experience with primary tetralogy of Fallot (TOF) repair, and identify predictors of intensive care unit (ICU) morbidity.MethodsWe analyzed perioperative and midterm follow-up data for all cases of primary TOF repair from 2001 to 2012. The primary endpoint was early mortality and morbidity, and the secondary endpoint was survival and functional status at follow-up.ResultsNinety-seven patients underwent primary repair. The median age was 4.9 months (range, 1 to 9 months), and the median weight was 5.3 kg (range, 3.1 to 9.8 kg). There was no early surgical mortality. The incidence of junctional ectopic tachycardia and persistent complete heart block was 2% and 1%, respectively. The median length of ICU stay was 6 days (range, 2 to 21 days), and the median duration of mechanical ventilation was 19 hours (range, 0 to 136 hours). By multiple regression analysis, age and weight were independent predictors of the length of ICU stay, while the surgical era was an independent predictor of the duration of mechanical ventilation. At the 8-year follow-up, freedom from death and re-intervention was 97% and 90%, respectively.ConclusionPrimary 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.

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Section: Discussionsupporting

confidence: 94%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot

Egbe

Nguyen

Mittnacht

et al. 2014

Korean J Thorac Cardiovasc Surg

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“…All of these findings are important and highlight the fact that 22q11.2DS results in increased morbidity, rather than mortality, in this particular patient population. 8,9, 25 The same may not be true in the more complicated cohort with major aorto-pulmonary collateral arteries requiring staged repairs as suggested by Mahle et al 7 …”

Section: Discussionmentioning

confidence: 95%

“…7 In addition, non-cardiac abnormalities and malformation syndromes appear to be independent risk factors for prolonged intubation, re-intubation and longer intensive care duration. 8, 9 Therefore, factors related to genotype influence outcomes.…”

Section: Introductionmentioning

confidence: 99%

22q11.2 Deletion syndrome is associated with perioperative outcome in tetralogy of Fallot

Mercer‐Rosa

Pinto

Yang

et al. 2013

The Journal of Thoracic and Cardiovascular Surgery

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Objectives We sought to investigate the impact of 22q11.2 deletion on perioperative outcome in tetralogy of Fallot. Methods We conducted a retrospective review of patients with tetralogy of Fallot who underwent complete surgical reconstruction at The Children’s Hospital of Philadelphia between 1995 and 2006. Inclusion criteria included diagnosis of tetralogy of Fallot and known genotype. Fisher’s exact and Mann Whitney tests were used for categorical and continuous variables, respectively. Regression analysis was used to determine whether deletion status predicts outcome. Results We studied 208 subjects with tetralogy of Fallot, 164 (79%) without, and 44 (20%) with a 22q11.2 deletion (22q11.2DS). There were no differences in sex, race, gestational age, age at diagnosis, admission weight, and duration of mechanical ventilation. Presenting anatomy, survival, complications and re-operations were also comparable between patients with and without 22q11.2DS. Those with 22q11.2DS had more aortopulmonary shunts preceding complete surgical repair (21% vs. 7%, p= 0.02). This association was present after adjustment for presenting anatomy (stenosis, atresia, or absence of pulmonary valve and common atrioventricular canal) and surgical era. In addition, those with 22q11.2DS had longer cardiopulmonary bypass time (84 vs. 72 minutes, p=0.02), and duration of intensive care (6 days vs. 4 days, p=0.007). Conclusions Genotype affects early operative outcomes in tetralogy of Fallot resulting, in particular, in longer duration of intensive care. Future studies are required to determine factors contributing to such differences in this susceptible population.

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Tetralogy of Fallot

Stewart

Mavroudis

Backer

2012

Pediatric Cardiac Surgery

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The influence of perioperative factors on outcomes in children aged less than 18 months after repair of tetralogy of Fallot

Abstract: Primary repair at an early age has excellent short-term outcome. Patients less than 3 months of age have an increased but transient intensive care unit morbidity.

Cited by 58 publications

References 24 publications

Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot

Predictors of Intensive Care Unit Morbidity and Midterm Follow-up after Primary Repair of Tetralogy of Fallot

22q11.2 Deletion syndrome is associated with perioperative outcome in tetralogy of Fallot

Tetralogy of Fallot

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