Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair

Arafat, Amr A.; Elatafy, Elatafy E.; Elshedoudy, Sahar; Zalat, Mahmoud; Abdallah, Neamet; Elmahrouk, Ahmed F.

doi:10.1186/s13019-018-0702-0

Cited by 18 publications

(24 citation statements)

References 20 publications

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“…[ 20 ] Our surgical strategies have been shifted from the use of TAP to preservation of the pulmonary valve if possible as it has a proved efficacy in reducing the incidence of postoperative pulmonary regurgitation. [ 21 ] Nevertheless, TAP was not associated with JET in our series. Some authors documented a significant association between JET and prolonged ischemic and cardiopulmonary bypass time and higher bypass temperature [ 17 , 22 – 24 ].…”

Section: Discussioncontrasting

confidence: 52%

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years

Ismail

Arafat

Hamouda

et al. 2018

J Cardiothorac Surg

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BackgroundJunctional ectopic tachycardia is a serious arrhythmia that frequently occurs after tetralogy of Fallot repair. Arrhythmia prophylaxis is not feasible for all pediatric cardiac surgery patients and identification of high risk patients is required. The objectives of this study were to characterize patients with JET, identify its predictors and subsequent complications and the effect of various treatment strategies on the outcomes in selected TOF patients undergoing total repair before 2 years of age.MethodsFrom 2003 to 2017, 609 patients had Tetralogy of Fallot repair, 322 were included in our study. We excluded patients above 2 years and patients with preoperative arrhythmia. 29.8% of the patients (n = 96) had postoperative JET.ResultsJET patients were younger and had higher preoperative heart rate. Independent predictors of JET were younger age, higher preoperative heart rate, cyanotic spells, non-use of B-blockers and low Mg and Ca (p = 0.011, 0.018, 0.024, 0.001, 0.004 and 0.001; respectively). JET didn’t affect the duration of mechanical ventilation nor hospital stay (p = 0.12 and 0.2 respectively) but prolonged the ICU stay (p = 0.011). JET resolved in 39.5% (n = 38) of patients responding to conventional measures. Amiodarone was used in 31.25% (n = 30) of patients and its use was associated with longer ICU stay (p = 0.017). Ventricular pacing was required in 4 patients (5.2%). Median duration of JET was 30.5 h and 5 patients had recurrent JET episode. Timing of JET onset didn’t affect ICU (p = 0.43) or hospital stay (p = 0.14) however, long duration of JET increased ICU and hospital stay (p = 0.02 and 0.009; respectively).ConclusionJET increases ICU stay after TOF repair. Preoperative B-blockers significantly reduced JET. Patients with preoperative risk factors could benefit from preoperative arrhythmia prophylaxis and aggressive management of postoperative electrolyte disturbance is essential.

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Section: Discussioncontrasting

confidence: 52%

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years

Ismail

Arafat

Hamouda

et al. 2018

J Cardiothorac Surg

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“…Similar to other series, which reported reoperation for RVOT obstruction and arch obstruction [26,27]. Several techniques were described to decrease the RVOT reoperation [28]. IAA was associated with a high reoperation rate because of arch obstruction; we had one patient with IAA who did not require further reoperation.…”

Section: Discussionsupporting

confidence: 77%

Surgical repair for persistent truncus arteriosus in neonates and older children

Alamri

Dohain

Arafat

et al. 2020

J Cardiothorac Surg

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Objectives: Persistent truncus arteriosus represents less than 3% of all congenital heart defects. We aim to analyze mid-term outcomes after primary Truncus arteriosus repair at different ages and to identify the risk factors contributing to mortality and the need for intervention after surgical repair. Methods: This retrospective cohort study included 36 children, underwent repair of Truncus arteriosus in the period from January 2011 to December 2018 in two institutions. We recorded the clinical and echocardiographic data for the patients preoperatively, early postoperative, 6 months postoperative, then every year until their last documented follow-up appointment. Results: Thirty-six patients had truncus arteriosus repair during the study period. Thirty-one patients had open sternum post-repair, and two patients required extracorporeal membrane oxygenation. Bleeding occurred in 15 patients (41.67%), and operative mortality occurred in 5 patients (14.7%). Patients with truncus arteriosus type 2 (p = 0.008) and 3 (p = 0.001) and who were ventilated preoperatively (p < 0.001) had a longer hospital stay. Surgical re-intervention was required in 8 patients (22.86%), and 11 patients (30.56%) had catheter-based reintervention. Freedom from reintervention was 86% at 1 year, 75% at 2 years and 65% at 3 years. Survival at 1 year was 81% and at 3 years was 76%. High postoperative inotropic score predicted mortality (p = 0.013). Conclusion: Repair of the truncus arteriosus can be performed safely with low morbidity and mortality, both in neonates, infants, and older children. Re-intervention is common, preferably through a transcatheter approach.

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“…Prophylactic tricuspid valve repair was recommended during the primary repair of TOF to decrease the reoperation rate. 2 VSD repair was the most common indication for reoperation in our series (55%). Lower rates were reported in other series.…”

Section: Discussionmentioning

confidence: 76%

“…1 Total primary repair is the recommended treatment; however, staged correction is still performed in some centers, especially in symptomatic infants under three months of age. 2 The surgical results of total repair of TOF have improved because of the advancement of the operative techniques and perioperative care, Despite the improved survival, several complications were reported over the long-term follow-up. 3 Arrhythmia is common after TOF repair because of the right ventricular incision.…”

Section: Introductionmentioning

confidence: 99%

“…6 Surgical techniques have evolved further to perform a trans-atrial repair to avoid ventricular incision; additionally, it is recommended to avoid pulmonary trans-annular patch and perform concomitant tricuspid repair during the primary TOF correction. 2 Reoperations are after TOF repair are frequent, and few studies are describing this problem in our region. Our objectives were to report our indications, surgical procedures, and the clinical outcomes of patients Disclosure: The authors have no financial interest to declare in relation to the content of this article.…”

Section: Introductionmentioning

confidence: 99%

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Reoperation after total correction of fallot

Eldesouky

Gamil

Sharaa

et al. 2020

Al-Azhar International Medical Journal

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Background: Reoperations after tetralogy of Fallot repair is common. This study aimed to report our indications, surgical procedures, and the clinical outcomes of patients undergoing reoperation after surgical correction of TOF. Patient and Methods: We included 40 patients who underwent reoperations after total TOF repair between 2015 and 2019. We included patients who had symptomatic right ventricular failure, patients with residual ventricular septal defect (VSD), right ventricular outflow tract obstruction (RVOTO), and tricuspid or pulmonary valve regurgitation. Results: The median age was 5.5(3.5-12.5) years, and 28(70%) were males. The median age at the time of primary repair was 2 (1-6) years. The end-systolic right ventricular (RV) volume estimated by MRI was 110.33±4.93 cc, and the end-diastolic volume was 208 ±10.08 cc. Twentytwo patients had VSD closure (55%), a transannular patch in 6 patients (15%), and RVOT resection in 14 patients(35%). Pulmonary valve replacement was performed in 6 patients(15%) and tricuspid valve repair in 4 patients (10%). The duration of postoperative mechanical ventilation was 11.5 (9-16.5) hours, and two patients had operative mortality (5%). Two patients (5%) had residual RVOT pressure gradient, and four patients had tiny residual VSD(10%). After six months of follow-up, four patients had moderate pulmonary regurgitation (PR), and four patients had residual VSD (10%). After one year follow-up, two patients had moderate PR(5%). Conclusion: A residual ventricular septal defect is a common indication for reoperation after the primary repair of tetralogy of Fallot. The results of reoperations are good with the accepted incidence of postoperative morbidity and mortality.

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Surgical strategies protecting against right ventricular dilatation following tetralogy of Fallot repair

Cited by 18 publications

References 20 publications

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years

Junctional ectopic tachycardia following tetralogy of fallot repair in children under 2 years

Surgical repair for persistent truncus arteriosus in neonates and older children

Reoperation after total correction of fallot

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