Tetralogy of Fallot Repair in Developing Countries: International Quality Improvement Collaborative

Area of Science:

• Pediatric Cardiac Surgery
• Congenital Heart Disease Research
• Global Health Initiatives

Background:

• Limited data exists on surgical outcomes for tetralogy of Fallot (TOF) in low- and middle-income countries (LMICs).
• The International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) aims to enhance surgical results by reducing infection and mortality in LMICs.

Purpose of the Study:

• To identify risk factors for in-hospital mortality following tetralogy of Fallot (TOF) surgery in LMICs.
• To analyze surgical outcomes and associated risk factors within the IQIC database.

Main Methods:

• Analysis of 2,164 TOF cases from 32 centers in 20 LMICs (2010-2014) within the IQIC database.
• Exclusion of TOF cases with associated lesions.
• Logistic regression analysis to determine risk factors for in-hospital mortality.

Main Results:

• Overall mortality was 3.6% (78/2,164). Initial primary repair had 3.3% mortality, shunts had 8.0%, and secondary repairs had 1.6%.
• Major infections occurred in 5.9% of patients.
• Risk factors for death after initial primary repair included oxygen saturation <90% and weight/BMI for age below the fifth percentile. Older age at repair was not a significant risk factor.

Conclusions:

• TOF patients in LMICs often undergo surgery after age one, but older age is not a predictor of death.
• Nutritional status and hypoxemia are significantly associated with increased mortality and infection rates.
• Findings address a critical knowledge gap regarding pediatric cardiac surgery in resource-limited settings.