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Primary surgical repair of tetralogy of Fallot at under three months of age

Primary surgical repair of tetralogy of Fallot at under three months of age
Primary surgical repair of tetralogy of Fallot at under three months of age

Background: Classical management of small infants with tetralogy of Fallot has involved placement of a Blalock-Taussig shunt followed later by complete repair, rather than primary complete repair which is the strategy adopted in larger infants. Some advantages of early complete repair compared to a staged strategy have been shown. We sought to review our institutional outcomes. Methods: Patients under 3-months old undergoing complete surgical repair of tetralogy of Fallot in our institution between 2005 and 2015 were retrospectively reviewed and compared with an older control group matched by anatomical diagnosis and outflow tract intervention. Results: Fourteen index cases (group A) and 14 controls (group B) were identified. At surgery, the median age was 43 days and weight 4.2 kg in group A, and 130 days and 6.1 kg in group B. Nine of 14 in group A were admitted for surgery as emergencies compared to none in group B. Peak inotrope score (22.3 vs. 12.8, p = 0.02) and intensive care unit stay (4.4 vs. 2.6 days, p = 0.02) were higher in group A. Bypass and crossclamp times, duration of intubation, and total length of stay did not differ. Conclusions: We conclude that although babies undergoing early repair of tetralogy of Fallot have an increased need for intensive care support in the early postoperative period, the total length of stay is not prolonged despite more emergency admissions. As it is known that early repair may reduce long-term morbidity, we propose consideration of earlier complete repair of tetralogy of Fallot.

Age factors, Cardiac surgical procedures, Infant, Intensive care units, pediatric, Tetralogy of Fallot, Treatment outcome
0218-4923
529-534
Ho, Andrew B.
56ba9662-bf92-42ad-9e55-4137eaa4e20f
Bharucha, Tara
d8f5d152-31e0-49e7-99ac-5fdead9afef8
Jones, Eleanor
3c4342c8-9d2e-4d6d-9d04-7fc28d158592
Thuraisingham, Justin
d6fc0cc4-65d4-4d6c-93d7-1ba2f1717e9c
Kaarne, Markku
8c55e965-1294-4829-b01c-64a820244ca5
Viola, Nicola
e5b75d0f-495a-4b87-94c4-2330ae21994c
Ho, Andrew B.
56ba9662-bf92-42ad-9e55-4137eaa4e20f
Bharucha, Tara
d8f5d152-31e0-49e7-99ac-5fdead9afef8
Jones, Eleanor
3c4342c8-9d2e-4d6d-9d04-7fc28d158592
Thuraisingham, Justin
d6fc0cc4-65d4-4d6c-93d7-1ba2f1717e9c
Kaarne, Markku
8c55e965-1294-4829-b01c-64a820244ca5
Viola, Nicola
e5b75d0f-495a-4b87-94c4-2330ae21994c

Ho, Andrew B., Bharucha, Tara, Jones, Eleanor, Thuraisingham, Justin, Kaarne, Markku and Viola, Nicola (2018) Primary surgical repair of tetralogy of Fallot at under three months of age. Asian Cardiovascular and Thoracic Annals, 26 (7), 529-534. (doi:10.1177/0218492318803037).

Record type: Article

Abstract

Background: Classical management of small infants with tetralogy of Fallot has involved placement of a Blalock-Taussig shunt followed later by complete repair, rather than primary complete repair which is the strategy adopted in larger infants. Some advantages of early complete repair compared to a staged strategy have been shown. We sought to review our institutional outcomes. Methods: Patients under 3-months old undergoing complete surgical repair of tetralogy of Fallot in our institution between 2005 and 2015 were retrospectively reviewed and compared with an older control group matched by anatomical diagnosis and outflow tract intervention. Results: Fourteen index cases (group A) and 14 controls (group B) were identified. At surgery, the median age was 43 days and weight 4.2 kg in group A, and 130 days and 6.1 kg in group B. Nine of 14 in group A were admitted for surgery as emergencies compared to none in group B. Peak inotrope score (22.3 vs. 12.8, p = 0.02) and intensive care unit stay (4.4 vs. 2.6 days, p = 0.02) were higher in group A. Bypass and crossclamp times, duration of intubation, and total length of stay did not differ. Conclusions: We conclude that although babies undergoing early repair of tetralogy of Fallot have an increased need for intensive care support in the early postoperative period, the total length of stay is not prolonged despite more emergency admissions. As it is known that early repair may reduce long-term morbidity, we propose consideration of earlier complete repair of tetralogy of Fallot.

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More information

e-pub ahead of print date: 14 September 2018
Published date: September 2018
Keywords: Age factors, Cardiac surgical procedures, Infant, Intensive care units, pediatric, Tetralogy of Fallot, Treatment outcome

Identifiers

Local EPrints ID: 426904
URI: http://eprints.soton.ac.uk/id/eprint/426904
ISSN: 0218-4923
PURE UUID: 6d13bfb9-8477-4f0d-97b1-c7d285c56623

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Date deposited: 14 Dec 2018 17:30
Last modified: 15 Mar 2024 22:02

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Contributors

Author: Andrew B. Ho
Author: Tara Bharucha
Author: Eleanor Jones
Author: Justin Thuraisingham
Author: Markku Kaarne
Author: Nicola Viola

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