Staged surgical management of tetralogy of Fallot in infants.

Stephenson, Larry W.; Friedman, Samuel H.; Edmunds, L. Henry

doi:10.1161/01.cir.58.5.837

Cited by 21 publications

(3 citation statements)

References 18 publications

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“…Particularly, the staged surgical approach has been recommended for infants under 1 year of age and infants with unfavorable anatomy [5,6]. However, the debate over staged repair and early total correction continues.…”

Section: Discussionmentioning

confidence: 99%

Outcome of Staged Repair of Tetralogy of Fallot with Pulmonary Atresia and a Ductus-dependent Pulmonary Circulation: Should Primary Repair Be Considered?

Kim

Sung

Chang

et al. 2011

Korean J Thorac Cardiovasc Surg

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BackgroundThe tetralogy of Fallot (TOF) with pulmonary atresia (PA) and a ductus-dependent pulmonary circulation (no major aorto-pulmonary collateral arteries (MAPCAs)) has been treated with staged repair or primary repair depending on the preference of surgeons or institutions. We evaluated the 19-year outcome of staged repair for this anomaly to find out whether our surgical strategy should be changed.Materials and MethodsForty-four patients with TOF/PA with patent ductus arteriosus (PDA) who underwent staged repair from June 1991 to October 2010 were included in this retrospective study. The patients with MAPCAs were excluded. The average age at the first palliative shunt surgery was 40.8±67.5 days (range: 0~332 days). Thirty-one patients (31/44, 70%) were neonates. The average weight was 3.5±1.6 kg (range: 1.6~8.7 kg). A modified Blalock-Taussig (BT) shunt was performed in 38 patients, classic BT shunt in 4 patients, and central shunt in 2 patients. Six patients required concomitant procedures: pulmonary artery angioplasty was performed in 4 patients, pulmonary artery reconstruction in one patient, and re-implantation of the left pulmonary artery to the main pulmonary artery in one patient. Four patients required a second shunt operation before the definitive repair was performed. Thirty-three patients underwent definitive repair at 24.2±13.3 months (range: 7.3~68 months) after the first palliative operation. The average age at the time of definitive repair was 25.4±13.5 months (range: 7.6~68.6 months) and their average weight was 11.0±2.1 kg. For definitive repair, 3 types of right ventricular outflow procedures were used: extra-cardiac conduit was performed in 30 patients, trans-annular patch in 2 patients, and REV operation in 1 patient. One patient was lost to follow-up after hospital discharge. The mean follow-up duration for the rest of the patients was 72±37 months (range: 4~160 months).ResultsTen patients (10/44, 22.7%) died before the definitive repair was performed. Four of them died during hospitalization after the shunt operation. Six deaths were thought to be shunt-related. The average time of shunt-related deaths after shunt procedures was 8.7 months (range: 2 days~25.3 months). There was no operative mortality after the definitive repair, but one patient died from dilated cardiomyopathy caused by myocarditis 8 years and 3 months after the definitive repair. Five-year and 10-year survival rates after the first palliative operation were 76.8% and 69.1%, respectively.ConclusionThere was a high overall mortality rate in staged repair for the patients with TOF/PA with PDA. Majority of deaths occurred before the definitive repair was performed. Therefore, primary repair or early second stage definitive repair should be considered to enhance the survival rate for patients with TOF/PA with PDA.

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Section: Discussionmentioning

confidence: 99%

Outcome of Staged Repair of Tetralogy of Fallot with Pulmonary Atresia and a Ductus-dependent Pulmonary Circulation: Should Primary Repair Be Considered?

Kim

Sung

Chang

et al. 2011

Korean J Thorac Cardiovasc Surg

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“…In particular, the precise indications for a transannular right ventricular outflow tract patch and the proportion ofpatients likely to need such a patch provided the focus for a number of important publications.8-'4 Similarly, the desirability of primary repair in symptomatic infants as compared with the alternative policy of palliation followed by secondary repair at a later age was, and still remains, a controversial issue. [13][14][15][16][17][18][19][20][21][22] The frequency with which a transannular patch has been used to repair the right ventricular outflow tract in Fallot's tetralogy has varied considerably in different series. -I023-25 Following the example of Gotsman et al,8 in the early years of our experience the pulmonary valve ring was preserved whenever possible in order to minimise pulmonary regurgitation.…”

Section: Discussionmentioning

confidence: 99%

Eight years' experience with intracardiac repair of tetralogy of Fallot. Early and late results in 175 consecutive patients.

Hamilton¹,

Eusanio²,

Piccoli³

et al. 1981

Heart

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The early and late results of intracardiac repair of 175 cases of tetralogy of Fallot during the period 1969 to 76 are reviewed. Overall hospital mortality was 8%, with a 5% mortality in patients over 2 years of age. Late mortality was 1%. Both early and late mortality and morbidity were related to the right ventricular to left ventricular peak systolic pressure ratio measured at the end of the operation. During the eight year period, a fall in mortality from 37 to 15% was recorded in patients less than 2 years of age. As a result of the experience gained during this period, we have now adopted a more active policy towards reconstruction of the right ventricular outflow tract while remaining aware of the potential problems of pulmonary regurgitation.

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“…However, the majority of institutions still prefer to delay definitive repair until at least 3 months of age, even in patients with a favorable anatomy. -In the presence of major associated cardiac anomalies such as multiple VSDs, associated atrioventricular septal defect, anomalous origin of the left anterior descending coronary artery from the right coronary artery, and pulmonary arterial hypoplasia and arborization abnormalities, a palliative shunt is preferred, as there is an increased postoperative mortality risk [7][8][9]. -An associated medical condition that could have an impact on patient care [7,9].…”

Section: Palliationmentioning

confidence: 99%

Tetralogy of fallot

Gouw

Sreeram

2001

Curr Treat Options Cardio Med

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The optimal surgical approach and timing for patients with tetralogy of Fallot remain controversial. There are two options in current practice: a two-stage repair (an initial palliative aortopulmonary shunt at an early age followed by complete repair at an older age) or primary complete repair. There has been a trend towards primary repair at a young age, which can be attributed to advances in anesthetic and cardiac surgical techniques. Primary repair has several advantages. The correction can be done in one operation and shunt complications are avoided. Progressive right ventricular fibrosis, ventricular hypertrophy, and chronic hypoxia are avoided, which may reduce the incidence of late ventricular arrhythmias. However, surgical correction at a young age is associated with an increased incidence of transannular patching and consequent pulmonary regurgitation. Progressive pulmonary regurgitation is associated with late ventricular arrhythmias and sudden death. These consequences may be prevented by timely pulmonary valve replacement. Palliative procedures include an aortopulmonary shunt, balloon dilation of the right ventricular tract, and stent placement. Of these measures, the aortopulmonary shunt is preferred, as it results in a more predictable outcome. Complications associated with shunt placement include shunt occlusion, pulmonary artery distortion, and occasionally, volume overloading of the left ventricle and pulmonary circulation. Institutional and surgeon preferences exist for either surgical strategy, and ultimately are justifiable when they produce the best outcomes for the individual patient. The optimal surgical strategy has to be determined by large prospective randomized studies that compare the functional status of the pulmonary valve and the need for reoperation at long-term follow-up.

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Staged surgical management of tetralogy of Fallot in infants.

Cited by 21 publications

References 18 publications

Outcome of Staged Repair of Tetralogy of Fallot with Pulmonary Atresia and a Ductus-dependent Pulmonary Circulation: Should Primary Repair Be Considered?

Outcome of Staged Repair of Tetralogy of Fallot with Pulmonary Atresia and a Ductus-dependent Pulmonary Circulation: Should Primary Repair Be Considered?

Eight years' experience with intracardiac repair of tetralogy of Fallot. Early and late results in 175 consecutive patients.

Tetralogy of fallot

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