Primary versus staged repair for tetralogy of Fallot in symptomatic neonates: systematic review and meta-analysis

The choice between primary repair and staged repair strategy for Tetralogy of Fallot remains a subject of debate in clinical practice. This review aims to compare the outcomes and efficacy of two surgical approaches in managing Tetralogy of Fallot among neonatal populations. Literature search was conducted across seven databases, identifying a total of 1393 relevant studies. Inclusion criteria encompassed comparative studies focusing on primary repair and staged repair for Tetralogy of Fallot in neonates. Quality of included studies was assessed using The Newcastle-Ottawa Scale for retrospective cohort studies. Data synthesis involved the extraction of post-operative outcomes. Meta-analysis was performed where feasible, pooling effect sizes to determine the overall impact of each repair strategy. Eight studies were selected for full-text appraisal. A total of 4464 Tetralogy of Fallot patients underwent surgical correction. The pooled mean patient age was 8.68 (±7.38) and 8.56 (±6.8) days for primary repair and staged repair, respectively. The primary repair was associated with a higher cardiac complications rate (odds ratio 1.50, 95% confidence interval 1.07 to 2.10) and transannular patch usage (odds ratio 2.62, 95% CI confidence interval 2.02 to 3.40). In contrast, staged repair was associated with longer hospital (mean difference 11.84, 95% confidence interval 9.59 to 14.10) and ICU (mean difference 3.06, 95% confidence interval 1.64 to 4.47) length of stay. However, no substantial differences were observed in terms of mortality and reintervention rates between these two approaches. The findings highlight the need for well-designed research and emphasise the importance of personalised approaches to address the intricate nature of Tetralogy of Fallot management in this population. Adjusting surgical approach to patient features may be necessary to maximise surgical outcomes.