Late correction of tetralogy of Fallot in children

Heinisch, Paul Philipp; Guarino, Laetitia; Hutter, Damian; Bartkevics, Maris; Erdoes, Gabor; Eberle, Balthasar; Royo, Carlos; Rhissass, Jaafar; Pfammatter, Jean‐Pierre; Carrel, Thierry; Kadner, Alexander

doi:10.4414/smw.2019.20096

Cited by 10 publications

(12 citation statements)

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“…The majority (66%) of patients in our cohort underwent valve-preserving surgery. Heinisch et al reported an exceedingly high rate of valve preservation in their cohort at 96%, which they attributed to unusually favourable pulmonary valve morphology and pulmonary annulus size in almost all of their patients [9]. In the other studies of complete repair of TOF in children older than one year of age, the rate of valve-preserving surgery was comparable to the rate in our study, ranging from 30% to 66.5% [8,[13][14][15].…”

Section: Discussionsupporting

confidence: 70%

“…The median ICU LOS in our study was 7 days (IQR 5-9) and the median hospital LOS was 12 days (IQR 10-16). All of the other similar studies on late complete repair of TOF in children reported shorter lengths of stay, with ICU LOS ranging from a mean of 1.8 ± 1.2 days to 5 ± 3 days and hospital LOS ranging from a mean of 7.6 ± 3.8 days to 15 ± 7 days [8,9,13,15]. Outcome studies on complete repair of TOF in infancy show either comparable or shorter ICU and hospital LOS compared with our study [16,17,21,22].…”

Section: Discussionsupporting

confidence: 65%

“…The 30-day mortality was 1.3% (4 patients) [15]. In another Swiss study, Heinisch et al reported no inhospital mortality among 25 children who underwent complete repair of TOF at a mean age of 5.9 ± 3.5 years [9]. In our study, 125 children had complete repair of TOF at a median age of 4.4 years (IQR 3-5.7), with no mortality at 30 days after surgery.…”

Section: Discussionmentioning

confidence: 39%

“…In many developing countries, because of poor access to medical care and lack of trained specialists, many children with TOF do not receive a timely diagnosis and therefore cannot benefit from early corrective surgery [8]. Instead, they are often operated on much later in childhood during humanitarian missions in their countries or through charitable organisations in specialized centres in developed countries [8,9]. In collaboration with the Swiss humanitarian organisation Terre des Hommes, the Lausanne University Hospital has had a longstanding programme of performing late correction of TOF in such children.…”

Section: Introductionmentioning

confidence: 99%

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Contemporary early results of late repair of tetralogy of Fallot in children: a single-centre case series

Mottier

Prša

2021

Swiss Med Wkly

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AIMS: To describe the early results of complete repair of tetralogy of Fallot (TOF) in children older than one year of age.METHODS: We identified all patients older than one year of age who underwent TOF repair between 2007 and 2017. Data collected included type of surgical repair, survival at 30 days after surgery, reintervention within 30 days of surgery, length of stay in the intensive care unit (ICU), length of stay in hospital, and degree of residual right ventricular outflow tract (RVOT) stenosis and pulmonary insufficiency 30 days after surgery. RESULTS: 125 children (median age 4.4 years, interquartile range [IQR] 3-5.7) underwent complete repair of TOF, with pulmonary valve preservation in 66%, a transannular patch in 19%, and a valved right ventricular-to-pulmonary artery conduit in 15%. All patients survived. There were twelve (9.6%) reinterventions. Median ICU length of stay was 7 days and median hospital length of stay was 12 days. Significant residual RVOT stenosis was present in 7.2% and significant pulmonary insufficiency in 19.2%. Patients with a transannular patch had a significantly higher proportion of significant residual RVOT stenosis and significant pulmonary insufficiency compared with the other types of surgical repair. CONCLUSIONS: Compared with the existing literature on complete late repair of TOF in children, this study showed good early results with no mortality, similar rates of reintervention and valve-preserving surgery, higher ICU and hospital length of stay, higher incidence of significant residual RVOT stenosis, and lower incidence of significant pulmonary insufficiency. Repair with a transannular patch was a risk factor for significant residual RVOT stenosis and significant pulmonary insufficiency.

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Section: Discussionsupporting

confidence: 70%

Section: Discussionsupporting

confidence: 65%

Section: Discussionmentioning

confidence: 39%

Section: Introductionmentioning

confidence: 99%

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Contemporary early results of late repair of tetralogy of Fallot in children: a single-centre case series

Mottier

Prša

2021

Swiss Med Wkly

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“…Total correction procedure for TOF has been performed for more than 40 years with the long-term outcome and quality of life have been considered excellent with only 3% mortality rate and more than 90% survival rate in 5 years (Atik 2004). The benefits of early repair are considered many, such as: reduce hypoxaemia duration and its negative sequelae, preserve myocardial function, stimulate angiogenesis in pulmonary vascular bed, and support lung growth (Heinisch et al 2019).…”

Section: Introductionmentioning

confidence: 99%

Mortality Risk Factors in Tetralogy of Fallot Patients Undergoing Total Correction

Juliana

Sembiring

Rahman

et al. 2021

FMI

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A total correction is a preferred treatment for Tetralogy of Fallot patients in every part of the world. However, the mortality in developing countries was as high as 6.9% to 15.3%. This was a retrospective analytic study that analyzed pre and post-operative risk factors that affected mortality on TOF patients that were performed total correction in Indonesia. A total of 47 TOF patients that were performed total correction from January 2016 to September 2019 were enrolled in this study based on the inclusion criteria. Preoperative and post-operative data were obtained from medical records. In this research, the majority of mortality was found in male patients (39.3%), while the female’s rate was lower (36.8%). Overall mortality was 38.3% and one operative death was found. The average age of patients was 84.12 months (12-210 months), whereas the average height (85.56 ± 36.17cm vs. 112.93 ± 21.73) and weight (17.22kg vs. 28.21kg) were lower for mortality patients. Some significant preoperative variables were identified as mortality risk factors such as: age below 60 months (p=0.047), smaller weight and height (p=0.008; p=0.002), abnormal hematocrit (p=0.002), and oxygen saturation below 75% (p=0.018). Significant post-operative risk factors included: temperature above 38.5⁰C (p=0.000), and ventilator time of more than 48 hours (p=0.033). In conclusion, the mortality of TOF patients undergoing a total correction in developing countries was quite high. It was associated with some risk factors, such as younger age, lower weight and height, low oxygen saturation, post-operative fever, and prolonged ventilator time.

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