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Primary early correction of tetralogy of Fallot irrespective of age*

Published online by Cambridge University Press:  06 February 2008

Andrea Kantorova ,
Kai Zbieranek ,
Henning Sauer ,
Christian Lilje ,
Christoph Haun  and
Viktor Hraska
Andrea Kantorova
Affiliation:
Slovak Pediatric Heart Centre, Bratislava, Slovakia; by invitation
Kai Zbieranek
Affiliation:
German Pediatric Heart Centre, Sankt Augustin
Henning Sauer
Affiliation:
German Pediatric Heart Centre, Sankt Augustin
Christian Lilje
Affiliation:
University Hospital Hamburg-Eppendorf, Hamburg, Germany
Christoph Haun
Affiliation:
German Pediatric Heart Centre, Sankt Augustin
Viktor Hraska*
Affiliation:
German Pediatric Heart Centre, Sankt Augustin
*
Correspondence to: Viktor Hraska, MD PhD, German Pediatric Heart Centre, Arnold-Janssen-Strasse 29, 53757 Sankt Augustin, Germany. Tel: +49 (2241) 249 601; Fax: +49 (2241) 249 602; E-mail: v.hraska@asklepios.com
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Abstract

Objective

The policy of early repair of patients with tetralogy of Fallot, irrespective of age, as opposed to initial palliation with a shunt, remains controversial. The aim of our study was to analyze the midterm outcome of primary early correction of tetralogy of Fallot.

Methods

Between 1996 and 2005, a total of 61 consecutive patients less than 6 months of age underwent primary correction of tetralogy of Fallot in two institutions. The median age at surgery was 3.3 months, and 27 patients (44%) were younger than 3 months of age, including 12 (20%) newborns. We analyzed the patients in 2 groups: those younger than 3 months of age, and those aged between 3 and 6 months.

Results

There was one early (1.6%), and one late death. Actuarial survival was 98.4%, 96.7%, 96.7% at 1, 5, and 10 years respectively, with a median follow up of 4.5 years. There was no difference in survival, bypass time, lengths of ventilation, and hospital stay between the groups. A transjunctional patch was placed significantly more often in the patients younger than 3 months (p = 0.039), with no adverse effect on survival and morbidity during the follow-up. Freedom from reoperation was 98.2%, 92.2%, and 83% at 1, 5, and 10 years respectively, with no difference between the groups.

Conclusion

Elective primary repair of tetralogy of Fallot in asymptomatic patients is delayed beyond 3 months of age. In symptomatic patients, primary repair of tetralogy of Fallot is performed irrespective of age, weight and preoperative state. This approach is safe, and provides an excellent midterm outcome with acceptable morbidity and rates of reintervention. The long-term benefits of this approach must be established by careful follow-up, with particular emphasis on arrhythmias, right ventricular function, and exercise performance.

Keywords

Congenital heart diseasecyanotic heart diseasecorrective surgery
Type
Original Article
Information
Cardiology in the Young , Volume 18 , Issue 2 , April 2008 , pp. 153 - 157
Copyright
Copyright © Cambridge University Press 2008

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Footnotes

*

The presentation on which this work is based was given at the Inaugural Meeting of the World Society for Pediatric and Congenital Heart Surgery, held in Washington, District of Columbia, May 3 and 4, 2007.

References

1. Pigula, FA, Khalil, PN, Mayer, JE, del Nido, PJ, Jonas, RA. Repair of tetralogy of Fallot in neonates and young infants. Circulation 1999; 100 (suppl II): 157–161.CrossRefGoogle ScholarPubMed
2. Hirsch, JC, Mosca, RS, Bove, EL. Complete repair of tetralogy of Fallot in the neonate: Results in the modern era. Ann Surg 2000; 232: 508–514.Google Scholar
3. Gladman, G, McCrindle, BW, Williams, WG, Freedom, RM, Benson, LN. The modified Blalock-Taussig shunt: clinical impact and morbidity in Fallot’s tetralogy in the current era. J Thorac Cardiovasc Surg 1997; 114: 25–30.Google Scholar
4. Vobecky, SJ, Williams, WG, Trusler, GA, et al. Survival analysis of infants under age 18 months presenting with tetralogy of Fallot. Ann Thorac Surg 1993; 56: 944–950.CrossRefGoogle ScholarPubMed
5. Castaneda, AR, Mayer, JE, Jonas, RA, Lock, JE, Wessel, DL, Hickey, PR. The neonate with critical congenital heart disease: repair, a surgical challenge. J Thorac Cardiovasc Surg 1989; 98: 861–875.CrossRefGoogle ScholarPubMed
6. Seliem, MA, Wu, YT, Glenwright, K. Relation between age at surgery and regression of right ventricular hypertrophy in tetralogy of Fallot. Pediatr Cardiol 1995; 16: 53–55.CrossRefGoogle ScholarPubMed
7. Walsh, EP, Rockenmacher, S, Keane, JF, Hougen, TJ, Lock, JE, Castaneda, AR. Late results in patients with tetralogy of Fallot repaired during infancy. Circulation 1998; 77: 1062–1067.Google Scholar
8. Touati, GD, Vouhe, PR, Amodeo, A, et al. Primary repair of tetralogy of Fallot in infancy. J Thorac Cardiovasc Surg 1990; 99: 396–403.CrossRefGoogle ScholarPubMed
9. Chowdhury, UK, Sathia, S, Ray, R, Singh, R, Pradeep, KK, Venugopal, P. Histopathology of the right ventricular outflow tract and its relationship to clinical outcomes and arrhythmias in patients with tetralogy of Fallot. J Thorac Cardiovasc Surg 2006; 132: 270–277.Google Scholar
10. Karl, TR, Sano, S, Pornvilliwan, S, Mee, RB. Tetralogy of Fallot: favorable outcome of nonneonatal transatrial, transpulmonary repair. Ann Thorac Surg 1992; 54: 903–907.Google Scholar
11. Steward, RD, Backer, CL, Young, L, Mavroudis, C. Tetralogy of Fallot: results of a pulmonary valve-sparing strategy. Ann Thorac Surg 2005; 80: 1431–1438.CrossRefGoogle Scholar
12. Reddy, VM, Liddicoat, JR, McElhinney, DB, Brook, MM, Stanger, P, Hanley, FL. Routine primary repair of tetralogy of Fallot in neonates and infants less than three months of age. Ann Thorac Surg 1995; 60 (6 suppl): S592–596.Google Scholar
13. Groh, MA, Meliones, JN, Bove, EL, et al. Repair of tetralogy of Fallot in infancy: effect of pulmonary artery size on outcome. Circulation 1991; 84 (suppl III): 206–212.Google Scholar
14. Ooi, A, Moorjani, N, Baliulis, G, et al. Medium term outcome for infants in tetralogy of Fallot: indications for timing of surgery. Eur J Cardiothorac Surg 2006; 30: 917–922.Google Scholar
15. Bacha, EA, Scheule, AM, Zurakowski, D, et al. Long-term results after early primary repair of tetralogy of Fallot. J Thorac Cardiovasc Surg 2001; 122: 154–161.Google Scholar
16. Redington, AN. Physiology of right ventricular failure. Semin Thorac Cardiovasc Surg Pediatr Card Surg Ann 2006; 9: 3–10.Google Scholar