Early outcome of total correction in adult tetralogy of fallot patients.

Abstract

<jats:p>Objectives: To detect the early outcome of total correction of Tetralogy of Fallot (TOF) in adult patients of age 16 years or above. Study Design: Retrospective descriptive case series. Setting: Paediatric Cardiac Surgery Department of Faisalabad Institute of Cardiology, Faisalabad. Period: October 2016 to June 2019. Material &amp; Methods: All consecutive patients of age 16 years or above who underwent total correction for TOF during study period were included. Surgical procedure and early outcome measures were recorded and analyzed. Results: Sixty nine patients underwent total correction for TOF during the study period. Majority of patients (n=55, 79.7%) were between16 to 25years of age. Male dominated the study population (56.5%, n=39) with male to female ratio 1.3: 1. Nine patients (13%) had coiling of MAPCA before surgery while prior palliation with Blalock Taussig shunt (BT Shunt) was seen in 5.8 % patients (n=4). All patients were operated with trans-atrial trans-pulmonary approach (n=69, 100%). Pulmonary artery was augmented with pericardial patch in 22 cases (32%) while left pulmonary artery (LPA) augmentation was done in two patients. Pulmonary valve annulus divided in 22 % of patients (n=15), RVOT was reconstructed with trans-annular pericardial patch in 10.1% patients (n=7) while Pulmonary valve was replaced with tissue valve in 7 patients (10.1%). In one patient RV to PA continuity was established with contegra. Post operatively Inotropic support was given for initial 39 ±45 hours, mean ICU stay was 39±75 hours, mean chest drainage 1086±741 ml and mean requirement for blood transfusion was 2.2 ±2.4 units. As regard early complications, six patients had tiny to small residual VSD (8.7%) while no patient developed complete heart block. Two patients had neurological damage (2.9%), one patient developed renal failure (1.45%) while chest reopening was done in two patients due to postoperative bleeding and/ or tamponade (2.9%). There was death of two patients (2.9%), one had renal failure due to low cardiac output (LCOS) and the other had stroke. Conclusion: The early outcome of complete repair of TOF in patients 16 years and above is good with a negligible mortality and limited number of complications.</jats:p>

Short-Term Outcomes Following Total Correction of Tetralogy of Fallot in Adult Patients

“…In this study the prevalence of male patients was higher, the same as the most other previous studies (9,11,14,20). Only in one study the prevalence of the female patients was higher (11).…”

“…al, bundle branch block (BBB) was found in more than half of the patients (19). MAPCA was diagnosed in 40.4% of the patients and it was higher than Khan et al and Khalid et al studies (4,9). One of the reasons for the higher prevalence of MAPCAs in our study could be the older age of our study patients compared to other studies, which increases the size of MAPCAs that can be identi ed in CT angiography.…”

“…During the recent decades the mortality rate of the TFTC surgery in the adult patients has decreased signi cantly (21). In the most of these studies the mortality rate ranged 1.8% to 8% (4,9,11,14,20,22). In our study in hospital mortality was 5.3% but in children who underwent TFTC at the recommended time, the mortality rate is lower than 2 percent (5).…”

“…al recommended 6 months of age (5) and several other studies suggested the age of 3 to 11 months for the TFTC surgery (6, 7) (6, 8). In contrast, in developing countries the patients might remain undiagnosed until adulthood (9). Furthermore, patients who do not have proper cardiac anatomy, suffer from severe cyanosis, have co-morbidities, undergo shunt implantation instead and complete surgery is delayed until they become older (4).…”

“…Addressing TOF at adult age is challenging not only for the complications of undiagnosed TOF during the years (e.g., Myocardial dysfunction, ventricular arrythmia, or even neurological complications) (9), but also for the possible di culties during the surgery and the related issues (10). In these patients, due to the fact that they have been exposed to hypoxia for a long time, there is a possibility of multiorgan damage (11)(12)(13)(14)(15)(16).…”