Total Correction of Tetralogy of Fallot at Early Age: A Study of 183 Cases

Alassal, Mohamed; Ibrahim, Bedir M.; Elrakhawy, Hany M.; Hassenien, Magdy; Sayed, Sameh; Elshazly, Magdy; Elsadeck, Nabil

doi:10.1016/j.hlc.2017.02.036

Cited by 3 publications

(4 citation statements)

References 15 publications

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“…[17][18][19] In several other reports, one-stage repair for young infants has been published with excellent early outcomes. [9][10][11][20][21][22] Despite the growing clinical evidence that early total correction of TOF can prevent later complications associated with long-standing RV hypertrophy, concerns regarding the safety of implementation of primary repair in the first 60 days of life remain. A review of Fallot correction from 1973 to 1988 showed 18.5% hospital mortality.…”

Section: Discussionmentioning

confidence: 99%

“…24 However, excellent results were later reported for total repair in neonates down to 0% hospital mortality. 10,20,22 Late complications such as sudden death have been reported with the two-stage TOF repair and may be related to time-dependent factors that occur prior to repair, leading to myocardial damage. Several researchers highlighted that those pathological changes eventually caused permanent heart damage; meanwhile, there was a lower incidence of ventricular arrhythmias among those repaired at younger ages.…”

Section: Discussionmentioning

confidence: 99%

“…Several researchers highlighted that those pathological changes eventually caused permanent heart damage; meanwhile, there was a lower incidence of ventricular arrhythmias among those repaired at younger ages. 19,20 Early relief of RV hypertrophy and fibrosis is of major significance in preventing the occurrence of RV dysfunction and arrhythmias later in life. 20,25 Seliem et al 26 in their study demonstrated the effect of early relief of RVOTO on RV morphology in relation to time and age of repair.…”

Section: Discussionmentioning

confidence: 99%

“…19,20 Early relief of RV hypertrophy and fibrosis is of major significance in preventing the occurrence of RV dysfunction and arrhythmias later in life. 20,25 Seliem et al 26 in their study demonstrated the effect of early relief of RVOTO on RV morphology in relation to time and age of repair. They showed that RV wall thickness and wall thickness to transverse dimension ratio has remarkably decreased in those patients who underwent total repair in the first 6 months of life in contrary to those who did the repair later as those did not show significant changes in these findings.…”

Section: Discussionmentioning

confidence: 99%

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Total Correction of Tetralogy of Fallot in the First 60 Days of Life in Symptomatic Infants: Is It The Gold Standard?

Menaissy

Omar

Mofreh

et al. 2019

Thorac cardiovasc Surg

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Background The timing of surgical repair of tetralogy of Fallot (TOF) is a key to alleviate complications and for long-term survival. Total correction was usually performed at the age of 6 months or older under the notion of decreasing the surgical risk. However, avoiding palliation with an aortopulmonary shunt and early correction of systemic hypoxia appear to be of more benefit than the inborn surgical risk in low body weight patients. Our objective was to assess early/midterm survival and operative complications and to analyze patients, surgical techniques, and morphological risk factors to determine their effects on outcomes. Patients and Methods We retrospectively reviewed 152 patients with TOF who were ≤60 days of age when they underwent total correction of TOF. All patients had either duct-dependent pulmonary blood flow or arterial blood oxygen saturation less than 65% on room air requiring urgent surgical correction. Exclusion criteria included TOF with pulmonary atresia, TOF with nonconfluent pulmonary arteries, TOF with multiple aortopulmonary collateral arteries, and associated complete atrioventricular septal defects. Results The mean age at repair was 34 ± 19 days, and the mean weight was 3.8 ± 0.9 kg. Before surgery, 96 patients received an infusion of prostaglandin, 45 were mechanically ventilated, and 32 required inotropic support. Right ventricular outflow tract obstruction was managed with a transannular patch in 112 patients, and all the others had a main pulmonary artery patch. Cardiopulmonary bypass (CPB) with moderate hypothermia was the standard, and the CPB time averaged 48 ± 21 minutes. The postoperative intensive care unit stay was 5.7 ± 6 days, with 2.8 ± 4 days of mechanical ventilation. Early mortality was 4.6% (7 of 152), and actuarial survival rates were 95% at 1 year and 92% at 5 years. Univariable and multivariable analyses of the patients' demographics, anatomical characteristics, and operative techniques revealed the presence of small pulmonary arteries and low body weight to be the only independent risk factors for death. Conclusion Early total correction of TOF during the first 60 days of life can be performed with low mortality and good intermediate-term survival and, from our point of view, “should be the gold standard for TOFs.”

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