Background: Tetralogy of Fallot (TOF) is one of the common cyanotic heart diseases. Now total repair is spreading to save children at younger age and lower body weight. The aim of this study was to evaluate the results of the two different surgical techniques used for total repair of tetralogy of Fallot: transatrial-transpulmonary approach and transventricular approach with special emphasis on preoperative and intraoperative risk factors that affecting the prognosis of patients, and with analysis of postoperative short-term results.
1.2. Patients and Methods: Between January 2014 and December 2016, sixty patients with TOF were randomly collected in a prospective study. Children divided into two groups, Group A included 30 patients repaired through transatrial-transpulmonary approach. Group B included 30 patients repaired through transventricular approach.
1.3. Results: Preoperative characteristics and variables of patients were similar. As regard to cardiopulmonary bypass time, cross-clamp time there were no significant differences(p>0.05). There were significant differences in ventilation time (p 0.023), inotropic support (p 0.001) and duration of stay in the ICU (p0.001). The incidence of arrhythmia 2 patients (6.7%) vs.5 patients (16.7%)] with non-significant difference. There is significant difference in right/left ventricular pressure ratio (p0.05). None of our children needed reintervention for residual VSD or significant RVOTO. There were three mortalities (5%), one in group A due to RV dysfunction and two in group B due to ventricular arrhythmia and RV dysfunction.
1.4. Conclusion: Total repair is the primary choice for management of FallotTetralogy.We encourage transatrial-transpulmonary repair to avoid ventricular incisions, otherwise a limited ventriculotomy is sufficient rather than extended ventriculotomy with transannular repair. |
