Determinants of short-term mortality and morbidity after the complete repair of tetralogy of Fallot in infant groups under 12 months and one-four years of age

Abstract

Fallot tetralojili on iki ay altı infantlar ile bir-dört yaş arası çocuk hasta gruplarında tam düzeltme ameliyatı sonrasında kısa dönem mortalite ve morbiditenin belirleyicileriDeterminants of short-term mortality and morbidity after the complete repair of tetralogy of Fallot in infant groups under 12 months and one-four years of age Özgün Araşt›rma Original Investigation 544Yaz›şma Adresi/Address ABSTRACTObjective: In patients with tetralogy of Fallot, infants less than 12 months old and children between one and four years old were compared after total repair surgery for determination of outcome of surgery, risk factors influencing mortality and morbidity. Methods: Fifty-two patients with tetralogy of Fallot between five months and four years of ages were included into the study. The patients were divided into two groups depending on their ages; Group 1; one year old and younger (n=21) whereas, group 2; one and four years old (n=31). Statistical analysis was performed using Mann-Whitney U, Chi-square or where appropriate Fisher's exact tests and logistic regression analysis was applied for determination of predictors of mortality.Results: The parameters that were different between two groups include; age (Group 1; 10.00±1.67 months and Group 2; 2.39±0.77 years, p<0.001), weight (Group 1; 9.74±2.23 kg, Group 2; 11.97±1.78 kg, p<0.001), McGoon ratio (Group 1; 1.94±0.29, Group 2; 2.19±0.27, p=0.001). Mortality is found in 3 patients in group 1 (14.2%) whereas, in five patients in group 2 (16%) and the difference was not statistically significant. In group 2 in only one patient (0.03%) had complete atrioventricular block and required permanent pacemaker implantation. When patients were compared according to groups with and without mortality, the significant differences were found in following variables: peritoneal dialysis (p=0.001), pleural effusion (p=0.02), right ventricular pressure (p=0.001) and right ventricle/aorta pressures ratio (p=0.001). However, none of these risk factors had significant value in prediction of mortality. GirişFallot tetralojisi (TOF) tüm doğumsal kalp hastalıklarının %10'nu oluşturur ve siyanotik kalp hastalıklarının da en başta gelenidir (1). Fallot tetralojisinin tedavisi cerrahidir. Tam düzelt-me yapılan TOF'lu hastaların %85'inin erişkin çağa ulaşabildikle-ri gözlemlenmektedir (2). Eskiden tam düzeltme için iki yaşına kadar beklemek tercih edilirken, son 30 yıllık süreçte eğer pulmoner yatak uygunsa, bir yaşından önce tam düzetme yapılmak-tadır. Erken dönemde tam düzeltme yapılması, iki aşamalı ameliyatın getirdiği riski ortadan kaldırır. Pulmoner arterlere ve akciğer parankimine erken dönemde normal kan akımını sağlayarak, kronik hipokseminin etkilerinden korur. Sağ ventrikül önündeki basınç yükü kalktığından sağ ventrikül hipertrofisi geriler. BarattBoyes (3) 1969'da, Castañeda ve ark. (4) 1972'de erken dönemde tam düzeltme ameliyatı sonrası iyi sonuçlarını bildirmişlerdir (5). Bu çalışmada TOF'lu 12 ay altı infantlar ile bir-dört yaş arası çocuk hasta gruplarında tam düzeltme am...

Early Outcomes of Total Correction in Tetralogy of Fallot in a Tertiary Care Hospital of Peshawar, Khyber Pakhtunkhwa, Pakistan; A Two-Year Retrospective Study

“…The mortality in pediatric age group is comparable to other developing countries, 5.7-14.2% but, it is still higher than the standards worldwide. 18,19 The mean Cardiopulmonary Bypass time and Aortic Cross Clamp time recorded in our study were 94.84±37.92 minutes and 67.17±31.86 minutes respectively which, as compared to a study by Egbe and colleagues, is comparatively higher. 17 Our mean CICU stay managed to be shorter as compared to studies by Hirsh et al who reported an average stay of 9±8 days, Kolcz and Pizarro reporting mean ICU stay of 7 days, and Tamesberger et al presented the average stay to be 6 days.…”

“…16,17 In developing countries however, the mortality rate for surgical repair of TOF in infants is 28-70 times higher than the developed countries because late surgical repair of TOF is a common practice in these countries. 18,19 The risk of complications such as suboptimal pulmonary vasculature development, pulmonary artery distortion, diastolic dysfunction, pulmonary vascular disease, end-organ dysfunction and right ventricular hypertrophy have increased due to twostaged operations for TOF. Later in life these sequelae can lead to life threatening arrythmias and even death.…”

Factors affecting perioperative mortality in tetralogy of Fallot

“…18 However, in a study of 52 patients by Sasmazel et al, no significant correlation was found between the McGoon index and perioperative mortality. 9 We also found that mortality had no significant correlation with the pulmonary annulus and peripheral This article is protected by copyright. All rights reserved.…”

Outcomes of Surgical Repair of Tetralogy of Fallot: A Comparison Between the Adult and Pediatric Population

“…In developed countries, primary surgical correction is usually done between the age of three to 12 months but due to a variety of factors, including delay in diagnosis, financial limitations, higher morbidity, and mortality due to lack of medical skills in underdeveloped countries, this is not a usual practice. Hence, accurate data on the morbidity and mortality of surgically corrected TOF cases are currently scarce in our countries [ 23 ].…”