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Short And Midterm Outcome Of Fallot's Tetralogy Repair In Infancy: A Single Center Experience In A Developing Country
Muhammad Kamran Younis Memon1, Saleem Akhtar1, Muhammad Mohsin1
1Department of Paediatrics and Child health, Aga Khan University Hospital, Karachi, Pakistan.
Insights
Tetralogy of Fallot (TOF) repair in infancy is safe, with acceptable outcomes. Low baseline saturation (≤75%) is a risk factor for complications, but surgical expertise has improved results over time.
Area of Science:
- Pediatric Cardiac Surgery
- Congenital Heart Disease Management
Background:
- Tetralogy of Fallot (TOF) repair in infancy is a critical intervention.
- Global preference for primary repair between 3-12 months emphasizes its importance.
- This study evaluates single-center outcomes in a developing country context.
Purpose of the Study:
- To review the experience and outcomes of Tetralogy of Fallot repair in infancy.
- To assess short- and midterm results in a developing country's healthcare setting.
- To identify risk factors affecting patient outcomes post-TOF repair.
Main Methods:
- Retrospective review of infant TOF repair cases from January 2007 to February 2018.
- Analysis of preoperative, operative, and postoperative data.
- Outcomes assessed included mortality, low cardiac output syndrome (LCOS), intubation duration, and hospital stay.
Main Results:
- Forty-four infants underwent TOF repair; 11.3% experienced mortality.
- Low baseline saturation (≤75%) was an independent risk factor for LCOS and prolonged intubation.
- Significant improvements in mortality and key perioperative metrics were observed in the latter six years of the study period.
Conclusions:
- Infant TOF repair is a safe procedure when performed by experienced surgical teams.
- Acceptable morbidity and mortality rates are achievable.
- Continuous improvement in surgical expertise has led to better outcomes over time.
Background:
Primary repair of ToF between 3-12 months is the preferred mode of treatment worldwide, with low surgical mortality. This study reviews our experience of ToF repair in infancy and its short and midterm outcomes in a single centre from a developing country.
Methods:
Data of all patients with Tetralogy of Fallot repair during infancy from January 2007 to Feb 2018 was reviewed. Preoperative, operative, and postoperative data was analysed. Outcome of the infants was assessed through discharge/death, low cardiac output syndrome (LCOS), prolonged intubation, duration of cardiac intensive care unit (CICU) and hospital stay.
Results:
Forty-four patients who underwent TOF repair in infancy during this period were included. The mean age and weight were 9.39±2.32 and 7.20±1.30 respectively, 77.3% (34 patients) were male, 68.18% (30 patients) had saturation >75%. Mean intubation period was 4.05±6.58 days, 12 (27.3%) patients developed LCOS, mean cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and ionotropic score were 133.52±62.4, 98.66±58.62 and 33.27±71.13 respectively. Mean CICU and hospital stay was 6.60±7.18 and 12.05±7.74 respectively. Five (11.3%) patients expired in postoperative period. Baseline saturation ≤75% is independent risk factor for LCOS and prolong intubation period. In the last six years our mortality decreased to 8% from 15.7% during the previous six years, while our mean intubation duration, CPB time, ACC, hospital stay and CICU stay have all shown improvement.
Conclusions:
TOF repair during infancy is safe procedure in expert hands with acceptable morbidity and mortality. Baseline saturation ≤75% is independent risk factor for LCOS and prolonged intubation period. Last six years have shown considerable improvement in our surgical morbidity and mortality due to improvement in surgical expertise.
