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Primary repair of tetralogy of Fallot in infancy
G D Touati1, P R Vouhé, A Amodeo
1Department of Cardiovascular Surgery, University Hospital Laennec, Paris, France.
Insights
This study shows that primary repair of symptomatic tetralogy of Fallot in infants is safe and effective, with improved surgical techniques and myocardial protection leading to excellent survival rates and no late deaths.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease
- Tetralogy of Fallot Repair
Background:
- Symptomatic tetralogy of Fallot (TOF) without pulmonary atresia requires surgical intervention in infancy.
- Optimal timing and surgical strategies for TOF repair remain areas of active research.
Purpose of the Study:
- To evaluate the outcomes of primary surgical repair in infants with symptomatic tetralogy of Fallot.
- To identify key factors influencing right ventricular outflow tract reconstruction.
- To assess the safety and efficacy of improved surgical management, including myocardial protection.
Main Methods:
- Retrospective analysis of 100 consecutive infants undergoing TOF repair (June 1983-April 1988).
- Ages ranged from 0.5 to 12 months; 70 patients received a transannular patch.
- Surgical management evolved, with enhanced myocardial protection (blood cardioplegia) in the latter half of the study.
Main Results:
- Hospital mortality was 3% (3 deaths), with no late deaths over 180 patient-years follow-up.
- Key factors for right ventricular outflow tract reconstruction were weight/pulmonary artery diameter ratio (p=0.0005) and BSA/pulmonary artery diameter ratio (p<0.0001).
- The last 48 patients had no operative deaths; predicted 30-day survivorship was 90%-99%.
Conclusions:
- Primary repair of symptomatic tetralogy of Fallot in infants is associated with excellent early and late outcomes.
- Improved surgical techniques and myocardial protection significantly enhance patient survival.
- The ratio of body size to pulmonary arterial outflow tract diameter is critical for successful surgical reconstruction.
Abstract:
From June 1983 to April 1988, 100 consecutive infants with symptomatic tetralogy of Fallot (without pulmonary atresia) were operated on. Ages ranged from 0.5 to 12 months (mean 7.3 +/- 3.7). Twenty patients were 0.5 to 3 months, 21 were 3 to 6 months, and 59 were 6 to 12 months of age. Mean weight was 6.5 kg +/- 1.7. Seventy patients received a transannular patch. The hospital mortality rate was 3% and there were no late deaths. Cumulative follow-up was 180 patient-years. Causes of death included hypoplastic pulmonary arteries (4 and 5 months old) and right ventricular failure (4 months old). The most important factors influencing right ventricular outflow tract reconstruction were neither weight (p = 0.90) nor age (p = 0.05) but rather were the ratio between weight and pulmonary arterial outflow tract diameter (p = 0.0005) and the ratio between body surface area and pulmonary arterial outflow tract diameter (p less than 0.0001). The last 48 patients were operated on with no deaths. During this period, operative management differed essentially in myocardial protection with blood cardioplegia. The predicted 30-day survivorship after repair was 90% to 99% (95% confidence limits). No ventricular arrhythmias have been detected after repair (mean follow-up 22.2 months). Mean right ventricular/left ventricular end-diastolic dimension ratio was (0.53 +/- 0.10 with M-mode echocardiography. These early results encourage us to proceed with primary repair of infants with symptomatic tetralogy of Fallot thanks to improved surgical management and enhanced myocardial protection.