Is there any need for a shunt in the treatment of tetralogy of Fallot with one source of pulmonary blood flow? Eur J Cardiothorac Surg 2013 Oct;44(4):648-54
Date
03/14/2013Pubmed ID
23482525DOI
10.1093/ejcts/ezt124Scopus ID
2-s2.0-84893413091 (requires institutional sign-in at Scopus site) 19 CitationsAbstract
OBJECTIVES: In symptomatic patients, performing a primary repair of tetralogy of Fallot (TOF), irrespective of age or placing a shunt, remains controversial. The aim of the study was to analyse the policy of primary correction.
METHODS: Between May 2005 and May 2012, a total of 87 consecutive patients with TOF, younger than 6 months of age, underwent primary correction. All patients had one source of pulmonary blood flow, with or without a patent ductus arteriosus. The median age at surgery was 106 ± 52.3 days (8-180 days). Twelve patients (13.8%) were newborns. Two groups were analysed: group I, patients <1 month of age; group II, patients between 2-6 months of age.
RESULTS: There was no early or late death at 7 years of follow-up. There was no difference in bypass time or hospital stay between the two groups, but the Aristotle comprehensive score (P < 0.0001), ICU stay (P = 0.030) and the length of ventilation (P = 0.014) were significantly different. Freedom from reoperation was 87.3 ± 4.3% and freedom from reintervention was 85.9 ± 4.2% at 7 years, with no difference between the two groups. Neurological development was normal in all patients, but 1 patient in Group II had cerebral seizures and showed developmental delay. Growth was adequate in all patients, except those with additional severe non-cardiac malformations that caused developmental delay. Eighty-five per cent of the patients were without cardiac medication.
CONCLUSIONS: Even in symptomatic neonates and infants <6 months of age, primary repair of TOF can be performed safely and effectively. One hundred per cent survival at 7 years suggests that early primary repair causes no increase in mortality in the modern era. Shunting is not necessary, even in symptomatic newborns, thus avoiding the risk of shunt-related complications and repeated hospital stays associated with a staged approach.
Author List
Arenz C, Laumeier A, Lütter S, Blaschczok HC, Sinzobahamvya N, Haun C, Asfour B, Hraska VAuthor
Viktor Hraska MD Professor in the Surgery department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
FemaleHumans
Infant
Infant, Newborn
Kaplan-Meier Estimate
Male
Postoperative Complications
Pulmonary Valve
Pulmonary Valve Insufficiency
Tetralogy of Fallot
Treatment Outcome
