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.” |
