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Published on: July 18, 2014
[Early one-stage repair of tetralogy of Fallot]
Beata Politowska1, Jadwiga A Moll, Paweł Dryzek
1Klinika Kardiologii, Instytut Centrum Matki Polki, ul. Rzgowska 281-289, 93-338 Łódź, Poland. bpolit@interia.pl
Insights
Early, one-stage surgical repair of Tetralogy of Fallot (TOF) in infants under six months shows low mortality and reoperation rates. This approach effectively eliminates the need for initial palliative procedures and medication.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
- Surgical Outcomes Research
Context:
- Tetralogy of Fallot (TOF) is a complex congenital heart defect requiring timely intervention.
- Early surgical repair in infants aims to improve long-term outcomes and reduce complications.
- Assessing the efficacy of primary repair in very young infants is crucial for treatment guidelines.
Purpose:
- To evaluate the results of early, primary surgical repair of Tetralogy of Fallot (TOF) in infants younger than six months.
- To determine the mortality rate, reoperation rate, and functional outcomes following this early intervention strategy.
- To assess the feasibility of single-stage repair without prior palliative procedures.
Summary:
- A study of 74 infants (1.5-6 months old) undergoing primary TOF repair between 1992-2003 found a survival rate of 96.4% (71 survivors).
- The mean follow-up was 4.9 years, with only one patient requiring reoperation (1.5%) and no patients exhibiting prolonged QRS complexes.
- Transannular patching was common (66%), with low incidence of significant residual obstruction or pulmonary insufficiency.
Impact:
- Early, one-stage repair of TOF in infants under six months is associated with favorable outcomes.
- This approach minimizes the need for staged palliation and long-term drug therapy.
- The findings support the consideration of primary repair as a standard treatment for eligible infants with TOF.
Objective:
To evaluate the outcome after early, primary repair of Tetralogy of Fallot (TOF) in children under 6 months of age.
Methods:
74 infants, who underwent repair of TOF between 1992 and 2003, aged from 1.5 to 6 months, were investigated. 32 (43%) patients were cyanotic, 14 (18%) had anoxemic spells. Most of them were qualified for surgical procedure by echocardiographic study only, 26 patients required cardiac catheterisation. Two had balloon angioplasty prior to primary repair. None of them underwent initial palliation. Mean follow-up was 4.9 years (1 -9.5 years).
Results:
71 children survived and they were in good condition. 3 patients died (mortality 3.6%). One child required reoperation. Transannular patch (TAP) was inserted in 66% of patients. Right ventricular outflow tract obstruction (RVOTO) more than 40 mmHg occurred in 2 infants. Moderate pulmonary insufficiency was present in 38 infants (25%). None of the patients had QRS complex longer than 140 msec.
Conclusions:
Early one-stage repair of TOF was achieved with low mortality rate and low risk for reoperation (1.5%). It eliminates initial palliation and drug therapy.
