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Young infants with symptomatic tetralogy of Fallot: Shunt or primary repair?

Xin Tao Ye1,2,3, Soichiro Henmi4, Edward Buratto1,2,3

  • 1Department of Cardiac Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.

JTCVS Open
|July 17, 2024
PubMed

Insights

For infants with tetralogy of Fallot (TOF), staged repair (SR) and primary repair (PR) show similar cardiac mortality and reintervention rates. Both strategies offer comparable outcomes for symptomatic infants undergoing surgical repair.

Area of Science:

  • Pediatric Cardiology
  • Congenital Heart Surgery
  • Medical Outcomes Research

Background:

  • Tetralogy of Fallot (TOF) is a complex congenital heart defect requiring surgical intervention in symptomatic infants.
  • The optimal surgical strategy, either staged repair (SR) or primary repair (PR), remains a subject of debate.
  • Two institutions with distinct, exclusive approaches to TOF repair provide a unique opportunity to compare these strategies.

Purpose of the Study:

  • To compare the clinical outcomes of staged repair (SR) versus primary repair (PR) in symptomatic young infants with tetralogy of Fallot (TOF).
  • To evaluate differences in mortality, postoperative complications, resource utilization, and reintervention rates between the two surgical approaches.

Main Methods:

  • A propensity score-matched analysis was conducted comparing infants under 4 months undergoing SR (n=143) versus PR (n=122) at two specialized centers.
  • The primary outcome was mortality, with secondary outcomes including complications, support durations, hospital stays, and reinterventions.
  • Median follow-up was 8.3 years, with a matched cohort of 57 pairs analyzed for detailed comparison.

Main Results:

  • Hospital mortality and 10-year survival rates were similar between SR and PR groups post-initial procedure.
  • The SR group experienced more early reinterventions, but late reintervention rates were comparable.
  • In the matched cohort, SR demonstrated similar freedom from reintervention but significantly greater 10-year survival, attributed to fewer non-cardiac deaths.

Conclusions:

  • In symptomatic infants with TOF, the staged repair (SR) strategy is associated with similar cardiac-related mortality and reintervention rates compared to primary repair (PR) at medium-term follow-up.
  • The choice between SR and PR may be influenced by institutional protocols and patient-specific factors.
  • Further research may elucidate long-term differences, particularly regarding non-cardiac outcomes.
Abstract

Keywords:
infantspalliationsurgerysymptomatictetralogy of Fallot

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