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Survival analysis of infants under age 18 months presenting with tetralogy of Fallot
S J Vobecky1, W G Williams, G A Trusler
1Department of Cardiovascular Surgery, Hospital for Sick Children, Toronto, Ontario, Canada.
Insights
Early repair of tetralogy of Fallot (TOF) shows similar survival rates to traditional staged repair. Assessing quality of survival is crucial for determining the superior treatment protocol for infants with TOF.
Area of Science:
- Pediatric Cardiology
- Congenital Heart Disease Surgery
Background:
- The management of tetralogy of Fallot (TOF) has evolved, with a trend towards early primary repair.
- Traditional protocols involve palliation in infancy if needed, followed by repair after infancy.
Purpose of the Study:
- To review the outcomes of the traditional staged repair protocol for tetralogy of Fallot in the current era.
- To compare survival rates between early primary repair and staged repair for infants with TOF.
Main Methods:
- Retrospective review of 270 infants with tetralogy of Fallot treated over a 10-year period.
- Analysis of survival rates based on the need for palliation and timing of interventions.
Main Results:
- Infants with isolated TOF had an 89% survival rate to age 10 years.
- Infants requiring neonatal palliation had significantly lower survival (77%) and higher rates of secondary procedures.
- Survival rates were similar between staged repair and early primary repair, but quality of life requires further assessment.
Conclusions:
- The overall survival for infants with tetralogy of Fallot is unlikely to differ significantly between primary and staged repair protocols.
- Further assessment of survival quality, including exercise capacity and arrhythmias, is necessary to determine the optimal treatment strategy.
Abstract:
The trend to perform early primary repair of tetralogy of Fallot prompted us to review our experience in the current era with the traditional protocol consisting of palliation during infancy, if required, and repair after infancy. During a 10-year period, 270 infants with tetralogy of Fallot presented aged less than 18 months. Thirteen infants (4.8%) had major noncardiac lesions that precluded definitive care for their congenital heart disease. Twenty infants (7.4%) had major associated cardiac lesions (atrioventricular septal defect or absent pulmonary valve syndrome, or both). Survival in this group was poor, with only 58% +/- 12% reaching the age of 10 years. Four of the seven deaths occurred before intracardiac repair was performed. The remaining 237 infants presented with isolated tetralogy of Fallot. Eight-nine percent +/- 2.3% survived to age 10 years. Sixty percent of these infants required palliation, and survival in these infants did not differ from that in those who never required palliation. However, 19 infants (8%) required palliation in the first month of life. In these children, survival to age 10 years was significantly lower (77%), secondary palliation was frequently required (n = 11), and a transannular patch or conduit at the time of repair (10 of 14 patients) was more likely needed than it was in children who had not undergone a palliative procedure during the neonatal period. The survival in infants with tetralogy of Fallot is unlikely to be different, regardless of whether primary repair or a staged repair is carried out. The quality of survival, including the exercise capability and absence of arrhythmias, must be assessed to determine which protocol is superior.