Young infants with severe tetralogy of Fallot: Early primary surgery versus transcatheter palliation

Abstract

Early primary repair for neonates may increase surgical reoperation, whereas transcatheter palliation comes at a cost of increased catheter reintervention. However, overall outcomes between groups, in terms of survival, growth, and hemodynamic parameters, were comparable, suggesting that both strategies are a reasonable option for children with severe tetralogy of Fallot.

Primary repair versus surgical and transcatheter palliation in infants with tetralogy of Fallot

“…Using a palliation method to allow for more somatic growth appears to be a preferable option, as both palliation methods appear to be comparable to PrR in these patients. Our finding, that using a transannular patch is associated with both increased mortality and future need for PVR, supports other data suggesting that a key aspect of repair is preserving the pulmonary valve when possible 5. It is reassuring that reinterventions in the first 10 years after ToF repair are not associated with increased mortality, only with further subsequent reinterventions.…”

“…Previous reports described a high incidence of PA reinterventions after RVOTd 5. After matching we found similar PA reintervention rates in all three groups.…”

“…Currently there is no consensus regarding the best strategy, with reports of good results with both early or neonatal repair,3 4 RVOTd5 and even SPS 2. We have previously shown that among all lesions with pulmonary obstruction, ToF had the lowest mortality after SPS palliation, with fewer such procedures being performed in these patients each year, likely due to better patient selection 6.…”

Predictors of Length of Hospital Stay After Complete Repair for Tetralogy of Fallot: A Prospective Cohort Study

“…In this study, neonatal repair was independently associated with longer THD. Other studies have shown that neonatal repair for TOF is associated with increased circulatory support time, length of mechanical ventilation, greater use of postoperative inotropes, longer LOHS, and subsequent reoperations . The neonatal heart might be less “mature” and more vulnerable in the symptomatic neonate with TOF and thus less able to tolerate exposures such as cardiopulmonary bypass and ventriculotomy during surgical repair.…”

“…Other studies have shown that neonatal repair for TOF is associated with increased circulatory support time, length of mechanical ventilation, greater use of postoperative inotropes, longer LOHS, and subsequent reoperations. 15,22,27,29,30 The neonatal heart might be less "mature" and more vulnerable in the symptomatic neonate with TOF and thus less able to tolerate exposures such as cardiopulmonary bypass and ventriculotomy during surgical repair. Neurologic vulnerability of the neonate as compared to infant may also be an important variable in this decision, but a variable that has not been fully addressed.…”