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Staged Versus Complete Repair in the Symptomatic Neonate With Tetralogy of Fallot
Jennifer Bailey1, Okan U Elci2, Christopher E Mascio3
1Division of Cardiology, Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania.
The Annals of Thoracic Surgery
|November 30, 2019
Summary
Neonatal complete repair of tetralogy of Fallot (TOF) increases early morbidity compared to staged repair, though survival is similar. Consider neonatal exposures for optimal TOF management strategies.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Surgery
- Neonatal Intensive Care
Background:
- Optimal management for symptomatic neonates with tetralogy of Fallot (TOF) is not established.
- This study compares outcomes of immediate complete repair versus staged repair in neonates with TOF.
Purpose of the Study:
- To compare the outcomes of neonatal complete repair versus palliation in symptomatic neonates with tetralogy of Fallot.
- To evaluate short-term and long-term results of different surgical strategies for TOF in neonates.
Main Methods:
- Retrospective cohort study of 138 neonates with TOF (2000-2013).
- Comparison of outcomes between neonatal complete repair (n=112) and staged repair (n=26).
- Outcomes assessed at multiple time points including post-repair events and cumulative events at 2 years.
Main Results:
- Demographics, anatomy, comorbidities, and mortality were similar between groups.
- Neonatal complete repair was associated with longer cardiopulmonary bypass, deep hypothermic circulatory arrest, intubation, intensive care, and hospital stay.
- No significant difference in total intensive care duration, hospital stay, or reinterventions when considering combined admissions for staged repair.
Conclusions:
- Both surgical strategies for tetralogy of Fallot in neonates yield similar survival rates.
- Neonatal complete repair is linked to higher early morbidity.
- The long-term neurocognitive impact of neonatal exposures (e.g., bypass, hypothermia, intensive care) warrants further investigation for optimal TOF management.
