Preoperative Home Monitoring for Neonates and Young Infants With Tetralogy of Fallot

Home monitoring programs (HMPs) have been implemented for high-risk postoperative patients with congenital heart diseases.

We recently extended the indications for HMPs to preoperative patients with tetralogy of Fallot (ToF). Thus, our purpose was to evaluate the current practice of home monitoring for preoperative patients with ToF, emphasizing the early detection of hypoxic spell events and the prevention of preoperative attrition. Furthermore, we sought to identify the risk factors for unplanned urgent operations during the home monitoring period and to evaluate the effects of these unplanned operations on long-term outcomes after repair.

Among 126 consecutive patients born with ToF between January 2020 and December 2021, 100 (59 boys) were enrolled in the preoperative HMP group. The risk factors for unplanned urgent operations during HMP were assessed using Cox regression.

The parents of 1 patient chose to undergo surgery at another hospital. Elective operations were performed in 79 patients (group 1, repair n = 74, systemic-to-pulmonary shunt n = 5) at a median age of 4 months (interquartile range [IQR], 3.5-4.9 months). In contrast, unplanned urgent operations were performed on 20 patients (group 2, repair n = 10, systemic-to-pulmonary shunt n = 10) at a median age of 1.2 months (IQR, 1.1-2.0 months). Risk factors for decreased time to unplanned urgent operations included a smaller pulmonary valve annulus (PVA) Z-score on follow-up echocardiography before surgery (P = .013; hazard ratio, 1.90 per 1 decrease) and lower daily minimum peripheral oxygen saturation (SpO2) (P < .001; hazard ratio, 1.16 per 1% decrease). There were no deaths. Complete repair was eventually performed on all patients (n = 99) at a median age of 4.1 months (IQR, 3.4-5.4 months), with PVA preservation in 95 patients (96%). Freedom from significant pulmonary stenosis or regurgitation at 24 months postrepair was similar between the 2 groups (P = .93).

Patients with preoperative ToF frequently require urgent unplanned operations, especially those with lower daily minimum SpO2 and insufficient postnatal PVA growth.