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Postoperative Complications in Humanitarian Paediatric Patients Undergoing Late Surgical Correction of Tetralogy of
Vitor Mendes1,2, Samuel Filliol1, Tomasz Nalecz1
1Division of Cardiovascular Surgery, Department of Surgery, Geneva University Hospitals (HUG), 1211 Geneva 14, Switzerland.
Insights
Late surgical repair of Tetralogy of Fallot in humanitarian pediatric patients has low mortality but significant complication risks. Identifying risk factors like pulmonary valve annulus size and ventilation time aids proactive management.
Area of Science:
- Cardiology
- Pediatric Surgery
- Global Health
Background:
- Tetralogy of Fallot necessitates early surgical correction.
- Delayed treatment is common in developing nations due to resource limitations.
- This study focuses on humanitarian patients with late surgical repair (>12 months).
Purpose of the Study:
- Identify risk factors for postoperative complications in humanitarian pediatric patients undergoing late Tetralogy of Fallot repair.
- Analyze pre/perioperative and postoperative risk factors.
- Provide insights for proactive clinical monitoring and resource optimization.
Main Methods:
- Retrospective analysis of 115 humanitarian pediatric patients.
- Median age at repair: 1444 days (approx. 4 years).
- Multivariable logistic regression models for risk factor analysis.
Main Results:
- 24.3% of patients experienced postoperative complications; no deaths recorded.
- Pre/perioperative factors: smaller pulmonary valve annulus and RV-PA conduit use increased risk.
- Postoperative factors: prolonged ventilation and hospitalization times were significant risk factors.
Conclusions:
- Late Tetralogy of Fallot repair in humanitarian settings has low mortality but high complication rates.
- Predictive models can guide proactive clinical monitoring and personalized management.
- Optimizing hospital resources is crucial for managing these complex cases.
Abstract:
Background: Tetralogy of Fallot is a congenital heart defect that requires early surgical correction. However, in developing countries, many patients undergo delayed treatment due to limited healthcare resources. This study aims to identify risk factors for postoperative complications in humanitarian patients undergoing late Tetralogy of Fallot repair, defined as surgery performed after 12 months of age. Methods: A retrospective analysis was conducted on 115 humanitarian paediatric patients with a median age of 1444 days (approximately 4 years) who underwent complete Tetralogy of Fallot correction. In this humanitarian programme, patients from developing nations underwent surgical repair at our tertiary referral centre in a high-resource country. Postoperative complications were monitored within the first 30 days after surgery. Two multivariable logistic regression models were used to analyse pre/perioperative (Model 1) and postoperative (Model 2) risk factors for complications. Results: Complications occurred in 24.3% of patients. No deaths were recorded. In Model 1, smaller pulmonary valve annulus (OR = 0.066; p < 0.01) and the use of right ventricle to pulmonary artery conduit (OR = 13.252; p < 0.01) were significantly associated with a higher risk of complications. In Model 2, prolonged invasive ventilation time (OR = 1.068; p < 0.01) and extended hospitalisation time (OR = 1.093; p = 0.04) were significantly associated with complications. Conclusions: Late surgical correction of Tetralogy of Fallot in humanitarian paediatric patients can be performed with low mortality but carries a significant risk of postoperative complications. The predictive models provide useful tools for proactive clinical monitoring, personalised management, and optimisation of hospital resources.
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