Comparison of In-Hospital Outcomes When Repair of Tetralogy of Fallot Is in the Neonatal Period Versus in the Post-Neonatal Period

Ghimire, Laxmi V.; Chou, Fu‐Sheng; Devoe, Christie; Moon-Grady, Anita J.

doi:10.1016/j.amjcard.2019.09.025

Cited by 14 publications

(15 citation statements)

References 14 publications

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“…Recent multicentre studies have shown that staged repair of ToF has superior outcome and less morbidity compared to single stage neonatal complete repair. [1][2][3] Although some studies did not show superiority of one approach over the other, and although some centers can achieve excellent results with early primary repair, 4,5 the decision to opt for a primary approach remains subjective and experience-based and may not be generalizable. Over the past decade, RVOT stenting in Fallot has been established as a good and frequently superior alternative to BT shunt for staged repair.…”

Section: Discussionmentioning

confidence: 99%

Anomalous coronary artery in Tetralogy of Fallot—Feasibility of right ventricular outflow tract stenting as initial palliation

Afifi

Mehta

Bhole

et al. 2022

Cathet Cardio Intervent

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This study addresses the outcome of right ventricle outflow tract (RVOT) stenting in Tetralogy of Fallot (ToF) with anomalous coronaries crossing the RVOT. RVOT stenting in ToF patients has emerged as an alternative to Blalock Taussig shunting. This is a single center study of patients who underwent RVOT stenting for symptomatic ToF at Birmingham Children's Hospital between 2005 and 2020. A total of 122 patients underwent RVOT stenting as initial palliation over a 15‐year period, 10 patients had anomalous coronaries crossing the RVOT (study group) and 112 not (comparative group). Median age of the study group was 72.5 days (interquartile range [IQR]: 28–103) with a weight of 4.7 kg (IQR: 3.5–4.9). No significant differences were found between the two groups regarding the patients’ weights and ages, procedure and screening times, or hospital stay. Four had valve sparing stenting. Oxygen saturations increased from a median of 75.5% (IQR: 70–82) to 94.5% (IQR: 90–95), p < 0.002. Postprocedure median hospital stay was 3 days (IQR: 2–6). Six patients underwent interstage catheterization reintervention and one needed early surgical palliation due to stent suboptimal position. Complete repair could be delayed for a median of 11.1 months (IQR: 5.6–19.2). At surgical repair, the patients had a median age of 12.3 months (IQR: 7.5–25.6) and weight of 7.7 kg (IQR: 6.8–10.8). There were no deaths. RVOT stenting in ToF with anomalous coronaries is safe and effective. Dilatable stents should be used when two‐stage delayed conduit repair is the default approach.

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Section: Discussionmentioning

confidence: 99%

Anomalous coronary artery in Tetralogy of Fallot—Feasibility of right ventricular outflow tract stenting as initial palliation

Afifi

Mehta

Bhole

et al. 2022

Cathet Cardio Intervent

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“…The risks associated with systemic to pulmonary shunts are well described and they include shunt thrombosis, pulmonary artery distortion, excess of volume load on the pulmonary vasculature and the left ventricle with potential pulmonary vasculature disease and congestive heart failure. (6)(7)(8)(9) In this study we are comparing approaches in symptomatic neonates with TOF who needed an intervention during the 30 days of life, we are not comparing early primary surgical repair versus late surgical repair, previous studies had shown that primary surgical repair at later age in infancy in asymptomatic TOF patients carries less morbidity and mortality than neonatal surgical repair (10,11).…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Complete Surgical Repair Versus Palliative Intervention in Neonates with Tetralogy of Fallot

Hamzah

Othman

Chedid

et al. 2021

Preprint

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Background: Surgical management of symptomatic neonates with Tetralogy of Fallot (TOF) is controversial. Either primary surgical repair (EPSR) in neonates with TOF or a staged palliation with initial palliative intervention (PI). Aim: Compare outcomes of neonates with TOF who had EPSR and those who had PI. Materials and Methods: The study utilized the US National Inpatient Sample dataset for the years 2000 to 2018. Patients with EPSR and those with PI (aortic to pulmonary shunt or cardiac catheter palliative intervention) identified. Results: A total of 29,292 neonates with TOF were identified; of them 1726 neonates had EPSR, 4363 had PI. Hospital mortality was similar in both groups (PI 7.4% vs EPSR 8.0%, p = 0.41). Patient in the PI group had more comorbidities; chromosomal anomalies (PI 13.2% vs. ESPR 7.8%, p < 0.001), prematurity (PI 15.1% vs. EPSR 10.4%, p < 0.001), and low birth weight < 2500 grams (PI 15.4% vs. EPSR 10.3%, p < 0.001). Median length of stay and median cost of hospitalization were significantly higher in the EPSR (25 days vs. 19 days, and $312,405 vs. $191,863, respectively, p < 0.001). Conclusion: EPSR had similar mortality to PI but comes with a higher resource utilization and complications. If we include the cumulative morbidity and resource utilization associated with a two staged repair, EPSR could be proven as a better strategy in symptomatic neonates with TOF. A prospective superiority study on symptomatic neonates with TOF randomized to either ESPR or PI is needed to further answer this question.

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“…The risks associated with SPS are well described and they include shunt thrombosis, pulmonary artery distortion, excess volume load on the pulmonary vasculature and the left ventricle with potential pulmonary vasculature disease and congestive heart failure 6–9 . In this study we are comparing approaches in symptomatic neonates with TOF who needed an intervention during the 30 days of life, we are not comparing EPSR versus late surgical repair, previous studies had shown that primary surgical repair at a later age in infancy in asymptomatic TOF patients carries less morbidity and mortality than neonatal surgical repair 10,11 …”

Section: Variables Early Primary Surgical Repair (N = 1726) Systemic‐...mentioning

confidence: 99%

“…[6][7][8][9] In this study we are comparing approaches in symptomatic neonates with TOF who needed an intervention during the 30 days of life, we are not comparing EPSR versus late surgical repair, previous studies had shown that primary surgical repair at a later age in infancy in asymptomatic TOF patients carries less morbidity and mortality than neonatal surgical repair. 10,11 We used data from a large multicenter national database that randomly samples 20% of the discharges from hospitals across the United States with both a large number of patients and a wide range of practice variations, this allowed us to evaluate the surgical management in neonates with TOF. An important finding on the current surgical practice of TOF is that only 28.4% of neonates had an early complete surgical repair, which eludes that the majority of centers prefer PI rather than early surgical repair in neonates with TOF.…”

mentioning

confidence: 99%

Outcomes of complete surgical repair versus palliative intervention in neonates with Tetralogy of Fallot

Hamzah

Othman

Chedid

et al. 2022

Pediatric Investigation

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Comparison of In-Hospital Outcomes When Repair of Tetralogy of Fallot Is in the Neonatal Period Versus in the Post-Neonatal Period

Cited by 14 publications

References 14 publications

Anomalous coronary artery in Tetralogy of Fallot—Feasibility of right ventricular outflow tract stenting as initial palliation

Anomalous coronary artery in Tetralogy of Fallot—Feasibility of right ventricular outflow tract stenting as initial palliation

Outcomes of Complete Surgical Repair Versus Palliative Intervention in Neonates with Tetralogy of Fallot

Outcomes of complete surgical repair versus palliative intervention in neonates with Tetralogy of Fallot

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