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Siddeek H, Lunos S, Thomas AS, McCracken C, Steinberger J, Kochilas L. Long Term Outcomes of Tetralogy of Fallot With Absent Pulmonary Valve (from the Pediatric Cardiac Care Consortium). Am J Cardiol 2021; 158:118-123. [PMID: 34511183 PMCID: PMC8614622 DOI: 10.1016/j.amjcard.2021.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/05/2021] [Revised: 07/25/2021] [Accepted: 07/27/2021] [Indexed: 11/30/2022]
Abstract
Tetralogy of Fallot with absent pulmonary valve (TOF-APV) is a rare form of tetralogy with unique challenges due to the combination of pulmonary annular stenosis, severe pulmonary regurgitation, and airway compression secondary to aneurysmal dilatation of the pulmonary arteries. Data on the long-term outcomes of repaired TOF-APV are scarce. We used the Pediatric Cardiac Care Consortium (PCCC), a large US-based registry, to describe the postrepair transplant-free survival of patients with TOF-APV. We queried the PCCC for patients operated for TOF-APV between 1982 and 2003. Death or transplant events were ascertained from the PCCC and by linkage with the US National Death Index and the Organ Procurement Transplantation Network through December 2019. A total of 126 patients were identified with TOF-APV repair (primary n = 119, staged n = 7). The majority of them were repaired with a right ventricular to pulmonary artery conduit (n = 80, 64%) and 43 (34%) with transannular patch. In-hospital mortality occurred in 31 patients (25%); post discharge and over a median period of 19 years (IQR 0.37 to 23.7 years), 5 patients died and 2 underwent heart transplant, one of whom subsequently died. The 25-year transplant-free survival post discharge after TOF-APV repair was 92%, which was similar with the outcome of patients with simple TOF undergoing non-valve sparing procedures (94% log-rank test p = 0.455; aHR 1.37; 95% CI: 0.63 to 2.97, p = 0.432). In conclusion, early in-hospital mortality is high for TOF-APV; however, once repaired and survived to discharge, long term survival is similar to simple TOF with non-valve sparing procedures.
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Affiliation(s)
- Hani Siddeek
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota; Department of Pediatrics, Division of Pediatric Cardiology, University of Utah, Salt Lake City, Utah.
| | - Scott Lunos
- University of Minnesota Clinical and Translational Science Institute, Biostatistical Design and Analysis Center, Minneapolis, Minnesota
| | - Amanda S Thomas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia
| | - Courtney McCracken
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Center for Research and Evaluation, Kaiser Permanente of Georgia
| | - Julia Steinberger
- University of Minnesota Masonic Children's Hospital, Minneapolis, Minnesota
| | - Lazaros Kochilas
- Department of Pediatrics, Emory University School of Medicine, Atlanta, Georgia; Children's Healthcare of Atlanta & Sibley Heart Center Cardiology, Atlanta, Georgia
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Hu JJ, Bonnichsen CR, Dearani JA, Miranda WR, Johnson JN, Cetta F, Stephens EH, Aganga DO, Van Dorn CS. Adults With Tetralogy of Fallot: Early Postoperative Outcomes and Risk Factors for Complications. Mayo Clin Proc 2021; 96:2398-2406. [PMID: 34412856 DOI: 10.1016/j.mayocp.2021.01.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Revised: 01/06/2021] [Accepted: 01/26/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE To report the early postoperative outcomes in adults with tetralogy of Fallot (TOF) undergoing cardiac surgery and to identify patient factors associated with complications. PATIENTS AND METHODS We performed a single-institution retrospective review of adults with TOF who underwent cardiac surgery from January 8, 2008, through June 21, 2018. Patients' characteristics, preoperative imaging, surgical interventions, outcomes, and complications were analyzed. RESULTS There were 219 adults with TOF (mean age, 40 years; range, 18-83 years; 88 [40%] female) in the study. Surgical interventions included repair or replacement of the pulmonary valve (n=199 [91%]), tricuspid valve (n=70 [32%]), mitral valve (n=13 [5.9%]), and aortic valve (n=8 [3.7%]). Three patients (1.4%) underwent first-time TOF repair. The 30-day mortality rate was 1.4% (n=3). Early postoperative complications occurred in 66 (30%) and included arrhythmias requiring treatment, dialysis requirement, liver dysfunction, respiratory failure, infection, reoperation, cardiac arrest, mechanical circulatory support, and death. Multivariate analysis found older age at current surgery (odds ratio [OR], 1.04 per year; 95% CI, 1.01 to 1.06; P<.001), longer cardiopulmonary bypass time (OR, 1.01 per minute; 95% CI, 1.01 to 1.02; P<.001), right ventricular systolic dysfunction (OR, 1.31; 95%, CI 1.02 to 1.69; P=.03), diabetes mellitus (OR, 3.50; 95% CI, 1.20 to 10.2; P=.02), and history of initial palliative surgery (OR, 1.99; 95% CI, 1.01 to 3.91; P=.05) as independent predictors of complications. CONCLUSION Surgical interventions for adult patients with TOF can be performed with low early morbidity and mortality. Clinical characteristics and preoperative testing parameters can predict risk for complications in the postoperative period.
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Affiliation(s)
- Jessie J Hu
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN
| | | | - Joseph A Dearani
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, MN
| | | | - Jonathan N Johnson
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | - Frank Cetta
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN
| | | | - Devon O Aganga
- Department of Anesthesiology and Perioperative Medicine, Division of Critical Care, Mayo Clinic, Rochester, MN; Department of Pediatric and Adolescent Medicine, Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, MN
| | - Charlotte S Van Dorn
- Department of Pediatric and Adolescent Medicine, Division of Pediatric Cardiology, Mayo Clinic, Rochester, MN; Department of Pediatric and Adolescent Medicine, Division of Pediatric Critical Care Medicine, Mayo Clinic, Rochester, MN.
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Blais S, Marelli A, Vanasse A, Dahdah N, Dancea A, Drolet C, Dallaire F. Comparison of Long-term Outcomes of Valve-Sparing and Transannular Patch Procedures for Correction of Tetralogy of Fallot. JAMA Netw Open 2021; 4:e2118141. [PMID: 34313740 PMCID: PMC8317016 DOI: 10.1001/jamanetworkopen.2021.18141] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
IMPORTANCE The choice of the right surgical technique for correction of tetralogy of Fallot (TOF) is contentious for patients with a moderate to severe right outflow tract obstruction. The use of a transannular patch (TAP) exposes patients to chronic pulmonary regurgitation, while valve-sparing (VS) procedures may incompletely relieve pulmonary obstruction. OBJECTIVE To compare 30-year outcomes of TOF repair after a VS procedure vs TAP. DESIGN, SETTING, AND PARTICIPANTS This retrospective population-based cohort study was conducted among all patients with TOF born in the province of Quebec, Canada, from 1980 to 2015 who underwent complete surgical repair. Patients who received a TAP or VS procedure were matched using a propensity score based on preoperative factors in a 1:1 ratio. Data were analyzed from March 2020 through April 2021. EXPOSURES The study groups were individuals who received TAP and those who received VS. The VS group was further stratified by the presence of residual pulmonary stenosis. MAIN OUTCOMES AND MEASURES The primary outcome was all-cause mortality, with 30-year survival evaluated using Cox proportional-hazards models. Secondary outcomes included the cumulative mean number of cardiovascular interventions, pulmonary valve replacements (PVRs), and cardiovascular hospitalizations were evaluated using marginal means/rates regressions. RESULTS Among 683 patients with TOF (401 patients who underwent TAP [58.7%] and 282 patients who underwent a VS procedure [41.3%]), adequate propensity score matching was achieved for 528 patients (264 patients who underwent a VS procedure and 264 patients who underwent TAP). Among this study cohort, 307 individuals (58.1%) were men. The median (interquartile range [IQR]) follow-up was 16.0 (8.1-25.4) years, for a total of 8881 patient-years, including 63 individuals (11.9%) followed up for more than 30 years. Individuals who received a VS procedure had an increased 30-year survival of 99.1% compared with 90.4% for individuals who received TAP (hazard ratio [HR], 0.09 [95% CI, 0.02-0.41]; P = .002). Patients who underwent TAP had an increased 30-year cumulative mean number of cardiovascular interventions compared with patients who underwent a VS procedure without residual pulmonary stenosis (2.0 interventions [95% CI, 1.5-2.7 interventions] vs 0.7 interventions [95% CI, 0.5-1.1 interventions]; mean ratio [MR], 0.36 [95% CI, 0.25-0.50]; P < .001) and patients who underwent a VS procedure with at least moderate residual stenosis (1.3 interventions [95% CI, 0.9-1.9 interventions]; MR, 0.65 [0.45-0.93]; P = .02). Results were similar for PVR, with a 30-year cumulative mean 0.3 PVRs [95% CI, 0.1-0.7 PVRs] for patients who underwent a VS procedure without residual pulmonary stenosis (MR, 0.22 [95% CI, 0.12-0.43]; P < .001) and 0.6 PVRs (95% CI, 0.2-1.5 PVRs) for patients with at least moderate residual stenosis (MR, 0.44 [95% CI, 0.21-0.93]; P = .03), compared with 1.4 PVRs (95% CI, 0.8-2.5 PVRs) for the TAP group. No statistically significant difference was found for cardiovascular hospitalizations. CONCLUSIONS AND RELEVANCE This study found that patients who underwent a VS procedure had increased 30-year survival, fewer cardiovascular reinterventions, and fewer PVRs compared with individuals who underwent TAP, even in the presence of significant residual pulmonary stenosis. These findings suggest that it is beneficial to perform a VS procedure when possible, even in the presence of moderate residual stenosis, compared with the insertion of a TAP.
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Affiliation(s)
- Samuel Blais
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
| | - Ariane Marelli
- McGill Adult Unit for Congenital Heart Disease Excellence, McGill University Health Centre, Montreal, Québec, Canada
| | - Alain Vanasse
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
- Department of Family Medicine and Emergency Medicine, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
| | - Nagib Dahdah
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire Sainte-Justine, Montreal, Québec, Canada
| | - Adrian Dancea
- Division of Pediatric Cardiology, McGill University Health Centre, Montreal, Québec, Canada
| | - Christian Drolet
- Division of Pediatric Cardiology, Centre Hospitalier Universitaire de Québec, Québec, Québec, Canada
| | - Frederic Dallaire
- Department of Pediatrics, Faculty of Medicine and Health Sciences, University of Sherbrooke, Sherbrooke, Québec, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Québec, Canada
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Ghimire LV, Devoe C, Moon-Grady AJ. 22q11.2 Deletion Status Influences Resource Utilization in Infants Requiring Repair of Tetralogy of Fallot and Common Arterial Trunk. Pediatr Cardiol 2020; 41:918-924. [PMID: 32112115 DOI: 10.1007/s00246-020-02333-y] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 02/21/2020] [Indexed: 11/26/2022]
Abstract
22q11.2 deletion syndrome leads to both cardiac and non-cardiac developmental defects. We aimed to study the impact of 22q11.2 deletion syndrome on in-hospital outcomes in children undergoing surgical repair for tetralogy of Fallot (TOF) and truncus arteriosus (TA). Using the nationally representative Kids Inpatient Database (KID), we analyzed data from in-hospital pediatric patients for the years 2003, 2006, 2009, and 2012. We compared the in-hospital outcomes between those with and those without 22q11.2 deletion syndrome. There were 6126 cases of TOF and 968 cases of TA. 22q11.2 deletion syndrome were documented in 7.2% (n = 441) of the TOF and 27.4% (n = 265) of the TA group. 22q11.2 deletion did not significantly increase the risk of mortality in either group: [OR = 1.98 (95% CI 0.99-3.94), adjusted p = 0.053] for TOF and OR = 1.07 (95% CI 0.57-1.99), adjusted p = 0.82 for TA. However, the length of hospitalization was longer in the 22q11.2 deletion group by 8.6 days (95% CI 5.2-12), adjusted p < 0.001 for TOF and by 8.15 days (95% CI 1.05-15.25), adjusted p = 0.025 for the TA group. Acute respiratory failure [10.6% vs 5.5%, p < 0.001] and acute renal failure [6.3% vs 2.6%, p < 0.001] were higher in 22q11.2 deletion cohort within the TOF group but not in the TA group. Though survival is not affected, children with 22q11.2 deletion syndrome who undergo surgical repair for TOF and TA use significantly more hospital resources-specifically longer hospital stay and higher hospitalization cost-than those without 22q11.2 deletion syndrome. Prenatal or preoperative testing for 22q11deletion is indicated to make appropriate adjustments in parental, caregiver, and administrative expectations.
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Affiliation(s)
- Laxmi V Ghimire
- Section of Pediatrics and Section of Cardiology, Department of Medicine, Lakes Region General Hospital, Laconia, NH, USA
- Department of Pediatrics, University of New England, Biddeford, ME, USA
| | - Christie Devoe
- Department of Pediatrics, University of New England, Biddeford, ME, USA
| | - Anita J Moon-Grady
- Division of Pediatric Cardiology, University of California, San Francisco, San Francisco, CA, USA.
- Division of Pediatric Cardiology, University of California, San Francisco, 550 16th Street 5th Floor, San Francisco, CA, 94158, USA.
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van Mil S, Heung T, Malecki S, Van L, Chang J, Breetvelt E, Wald R, Oechslin E, Silversides C, Bassett AS. Impact of a 22q11.2 Microdeletion on Adult All-Cause Mortality in Tetralogy of Fallot Patients. Can J Cardiol 2020; 36:1091-1097. [PMID: 32348848 DOI: 10.1016/j.cjca.2020.04.019] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Revised: 04/08/2020] [Accepted: 04/20/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Because of the importance of identifying factors that affect late outcomes in the increasing population of those with tetralogy of Fallot (TOF), we aimed to determine the effect of a 22q11.2 microdeletion on adult mortality, while accounting for pulmonary atresia, known to be enriched in 22q11.2 deletion syndrome (22q11.2DS). METHODS We studied 612 individuals with TOF recruited as adults at a single centre, 80 (13.1%) with molecularly confirmed 22q11.2 deletions and 532 without 22q11.2DS, followed for a total of 5961.3 person-years. Using a case-control design, Cox proportional hazard regression and Kaplan-Meier curves, we evaluated the effect of a 22q11.2 deletion on mortality and survival. RESULTS All-cause mortality was 1.87% per person-year in the 22q11.2DS-TOF group and 0.80% in the other-TOF group. The presence of a 22q11.2 microdeletion was a significant predictor of adult mortality in TOF (hazard ratio, 5.00; P < 0.0001), after accounting for pulmonary atresia (hazard ratio, 2.71; P = 0.0106) and other factors. Overall, individuals with 22q11.2DS died on average 17.7 years earlier (P = 0.0055) than others with TOF, predominantly of cardiovascular causes, with proportionately more sudden cardiac deaths in those with 22q11.2DS-TOF (n = 5 [38.5%] vs n = 5 [11.9%], other-TOF; P = 0.0447). Kaplan-Meier curves showed reduced survival for those with 22q11.2DS (P < 0.0001); probability of survival to age 45 years, without pulmonary atresia, was 72% (22q11.2DS-TOF) and 98% (other-TOF). CONCLUSIONS The results suggest that the 22q11.2 deletion significantly contributes to premature mortality in adults with TOF, mediated only in part by greater anatomic complexity. The interpretation of late outcome data in TOF will likely benefit from further genetic subtyping.
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Affiliation(s)
- Spencer van Mil
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Tracy Heung
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Sarah Malecki
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Lily Van
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Janis Chang
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada
| | - Elemi Breetvelt
- Department of Psychiatry, The Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rachel Wald
- Toronto Congenital Cardiac Centre for Adults, Division of Cardiology at the Peter Munk Cardiac Centre, Department of Medicine, University Health Network; and University of Toronto, Toronto, Ontario, Canada
| | - Erwin Oechslin
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada; Toronto Congenital Cardiac Centre for Adults, Division of Cardiology at the Peter Munk Cardiac Centre, Department of Medicine, University Health Network; and University of Toronto, Toronto, Ontario, Canada
| | - Candice Silversides
- The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada; Toronto Congenital Cardiac Centre for Adults, Division of Cardiology at the Peter Munk Cardiac Centre, Department of Medicine, University Health Network; and University of Toronto, Toronto, Ontario, Canada
| | - Anne S Bassett
- Clinical Genetics Research Program, Centre for Addiction and Mental Health, Toronto, Ontario, Canada; The Dalglish Family 22q Clinic, University Health Network, Toronto, Ontario, Canada; Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada; Toronto Congenital Cardiac Centre for Adults, Division of Cardiology at the Peter Munk Cardiac Centre, Department of Medicine, University Health Network; and University of Toronto, Toronto, Ontario, Canada; Toronto General Hospital Research Institute and Campbell Family Mental Health Research Institute, Toronto, Ontario, Canada.
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Ghimire LV, Chou FS, Devoe C, Moon-Grady A. Comparison of In-Hospital Outcomes When Repair of Tetralogy of Fallot Is in the Neonatal Period Versus in the Post-Neonatal Period. Am J Cardiol 2020; 125:140-145. [PMID: 31703806 DOI: 10.1016/j.amjcard.2019.09.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/21/2019] [Accepted: 09/24/2019] [Indexed: 11/28/2022]
Abstract
Tetralogy of Fallot (TOF) is the most common form of cyanotic congenital heart disease (CHD) and optimal timing for total repair of TOF is controversial. We hypothesize that TOF repair in the neonatal period is associated with worse outcomes compared with those who undergo repair later in infancy. We analyzed data using the Kids' Inpatient Database (KID) from 2003 to 2012. We used multivariable logistic regression analyses to compare the in-hospital outcomes between those who underwent total repair of TOF during the neonatal period vs the postneonatal period. There were 6,856 cases of TOF and 7.83% (n = 537) of those underwent repair during the neonatal period. The average mortality in all TOF repair was 2.1% (n = 147). In multiple regression model, compared with repair in postneonatal period, neonatal repair was associated with increased mortality, with adjusted odds ratio of 2.2 (95% confidence interval [CI]: 1.1 to 4.3, p = 0.023). Regarding complications, the neonatal group was associated with higher risk of acute renal failure (8.9% vs 2.3%, p <0.001), need for cardiac catheterization (18.6% vs 8.3%, p <0.001), and ECMO use (4.4% vs1.6%, p <0.001). There was no difference in the rates of arrhythmia, respiratory failure, pulmonary hypertension, or sudden cardiac arrest. Children who underwent repair in the neonatal period had longer hospital stay compared with the postneonatal group (45.5 days [95% CI: 39.3 to 51.7] vs 12.6 days [95% CI: 11.7 to 13.4], p <0.001). Hospital charges were higher for children who underwent repair in the neonatal period compared with those in the postneonatal period. In conclusion, TOF repair in the neonatal period is associated with higher rates of mortality, more postoperative complications, longer hospital stays, and higher hospitalization cost.
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Affiliation(s)
- Laxmi V Ghimire
- Section of Pediatrics and Section of Cardiology, Department of Medicine, Lakes Region General Hospital, Laconia, New Hampshire; Department of Pediatrics, University of New England, Biddeford, Maine.
| | - Fu-Sheng Chou
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Christie Devoe
- Department of Pediatrics, University of New England, Biddeford, Maine
| | - Anita Moon-Grady
- Division of Pediatric Cardiology, University of California, San Francisco, San Francisco, California
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Purifoy ET, Spray BJ, Riley JS, Prodhan P, Bolin EH. Effect of Trisomy 21 on Postoperative Length of Stay and Non-cardiac Surgery After Complete Repair of Tetralogy of Fallot. Pediatr Cardiol 2019; 40:1627-1632. [PMID: 31494702 DOI: 10.1007/s00246-019-02196-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 08/23/2019] [Indexed: 12/14/2022]
Abstract
Trisomy 21 (T21) is the most common chromosomal abnormality, and is frequently associated with congenital heart disease. Results of previous studies evaluating the effect of T21 on postoperative outcomes and complications following heart surgery have been mixed. Our goal was to determine if T21 is associated with higher frequency of adverse postoperative outcomes following repair of tetralogy of Fallot (TOF). A query of the Pediatric Health Information System was performed for patients who underwent complete repair of TOF from 2004 to 2015. Patients with a genetic syndrome other than T21 and tracheostomy and/or gastrostomy prior to heart surgery were excluded. Two groups were created on the basis of whether patients received a diagnostic code for T21. The adverse outcomes of interest were postoperative mortality, postoperative length of stay (LOS), postoperative gastrostomy, and postoperative tracheostomy. Univariate and Kaplan-Meier analysis were performed to evaluate outcomes. There were a total of 4790 patients; 430 (9%) patients had T21, and 4360 (91%) patients without a genetic diagnosis. There was no significant difference in mortality before discharge between those with and without T21 (2.3% vs 1.4%; p = 0.155). Patients with T21 had longer postoperative LOS (mean of 19.8 days vs 12.4 days; p < 0.001), and higher rates of postoperative gastrostomy (13.3% vs 5.3%; p < 0.02). There was no significant difference between groups for rates of postoperative tracheostomy (1.9% vs 1.2%; p = 0.276). Kaplan-Meier analysis confirmed that patients with T21 had longer postoperative LOS and greater incidence of gastrostomy.
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Affiliation(s)
- Eric T Purifoy
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA.
| | - Beverly J Spray
- Biostatistics Core, Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202-3591, USA
| | - Joe S Riley
- Biostatistics Core, Arkansas Children's Research Institute, 13 Children's Way, Little Rock, AR, 72202-3591, USA
| | - Parthak Prodhan
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
| | - Elijah H Bolin
- Department of Pediatrics, Section of Pediatric Cardiology, University of Arkansas for Medical Sciences and Arkansas Children's Research Institute, 1 Children's Way, Slot 512-3, Little Rock, AR, 72202-3591, USA
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Egbe AC, Vallabhajosyula S, Vojjini R, Banala K, Najam M, Faizee F, Khalil F, Ullah MW, Deshmukh AJ. Prevalence and in-hospital mortality during arrhythmia-related admissions in adults with tetralogy of Fallot. Int J Cardiol 2019; 297:49-54. [PMID: 31604657 DOI: 10.1016/j.ijcard.2019.09.001] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Revised: 07/18/2019] [Accepted: 09/04/2019] [Indexed: 11/18/2022]
Abstract
BACKGROUND Although outcomes of arrhythmia diagnosis have been described in ambulatory tetralogy of Fallot (TOF) patients, these have not been studied in hospitalized patients. The purpose of this study was to determine the prevalence and in-hospital mortality due to arrhythmias in TOF patients based on a review of the National Inpatient Sample database. METHODS Admissions in adult TOF patients (2000-2014) were categorized as arrhythmia-related admission (ARA) or non-arrhythmia-related admission (NRA) based on arrhythmia diagnostic codes. RESULTS Of 18,353 admissions, 5071 (27.6%) were ARA. The most common arrhythmias were atrial fibrillation (15.5%), atrial flutter (8.4%) and ventricular tachycardia (8.2%), and the prevalence of overall ARA as well as specific arrhythmia types increased over time. In-hospital mortality for ARA was 5.4%, and decreased over time. Arrhythmia diagnosis was an independent predictor of in-hospital mortality (odds ratio [OR] 1.63, 1.34-2.01, p = 0.001). Similarly, atrial fibrillation (OR 1.49, 1.18-1.89, p = 0.001) and ventricular tachycardia (OR: 2.01, 1.55-2.98, p = 0.001) were independent predictors of in-hospital mortality. Compared to small bed-size hospital, ARA in large hospital bed-size hospital was associated with a lower in-hospital mortality (OR 0.71, 0.53-0.96, p = 0.03). CONCLUSION Atrial fibrillation was the most common arrhythmia in hospitalized TOF patients, and arrhythmia diagnosis (specifically atrial fibrillation and ventricular tachycardia) was an independent predictor of in-hospital mortality, while admission to a large bed-size hospital was associated with a lower risk of in-hospital mortality. Further studies are required to determine if a more proactive approach to arrhythmia management in the ambulatory TOF population will reduce hospitalizations and mortality.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America.
| | | | - Rahul Vojjini
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Keerthana Banala
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Maria Najam
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Faizan Faizee
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Fouad Khalil
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Muhammad Wajih Ullah
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
| | - Abhishek J Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN 55905, United States of America
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Younis Memon MK, Akhtar S, Mohsin M, Ahmad W, Arshad A, Ahmed MA. Short And Midterm Outcome Of Fallot's Tetralogy Repair In Infancy: A Single Center Experience In A Developing Country. J Ayub Med Coll Abbottabad 2019; 31:383-387. [PMID: 31535511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
BACKGROUND Primary repair of ToF between 3-12 months is the preferred mode of treatment worldwide, with low surgical mortality. This study reviews our experience of ToF repair in infancy and its short and midterm outcomes in a single centre from a developing country. METHODS Data of all patients with Tetralogy of Fallot repair during infancy from January 2007 to Feb 2018 was reviewed. Preoperative, operative, and postoperative data was analysed. Outcome of the infants was assessed through discharge/death, low cardiac output syndrome (LCOS), prolonged intubation, duration of cardiac intensive care unit (CICU) and hospital stay. RESULTS Forty-four patients who underwent TOF repair in infancy during this period were included. The mean age and weight were 9.39±2.32 and 7.20±1.30 respectively, 77.3% (34 patients) were male, 68.18% (30 patients) had saturation >75%. Mean intubation period was 4.05±6.58 days, 12 (27.3%) patients developed LCOS, mean cardiopulmonary bypass (CPB) time, aortic cross clamp (ACC) time and ionotropic score were 133.52±62.4, 98.66±58.62 and 33.27±71.13 respectively. Mean CICU and hospital stay was 6.60±7.18 and 12.05±7.74 respectively. Five (11.3%) patients expired in postoperative period. Baseline saturation ≤75% is independent risk factor for LCOS and prolong intubation period. In the last six years our mortality decreased to 8% from 15.7% during the previous six years, while our mean intubation duration, CPB time, ACC, hospital stay and CICU stay have all shown improvement. CONCLUSIONS TOF repair during infancy is safe procedure in expert hands with acceptable morbidity and mortality. Baseline saturation ≤75% is independent risk factor for LCOS and prolonged intubation period. Last six years have shown considerable improvement in our surgical morbidity and mortality due to improvement in surgical expertise.
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Affiliation(s)
| | - Saleem Akhtar
- Department of Paediatrics and Child health, Aga Khan University Hospital, Karachi, Pakistan
| | - Muhammad Mohsin
- Department of Paediatrics and Child health, Aga Khan University Hospital, Karachi, Pakistan
| | - Waris Ahmad
- Department of Paediatrics and Child health, Aga Khan University Hospital, Karachi, Pakistan
| | | | - Mehnaz Atiq Ahmed
- Department of Paediatrics, Liaquat National Hospital, Karachi, Pakistan
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Egbe AC, Vallabhajosyula S, Akintoye E, Deshmukh A. Cardiac Implantable Electronic Devices in Adults with Tetralogy of Fallot. Am J Cardiol 2019; 123:1999-2001. [PMID: 30961908 DOI: 10.1016/j.amjcard.2019.03.010] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/06/2019] [Revised: 03/01/2019] [Accepted: 03/05/2019] [Indexed: 12/20/2022]
Abstract
Patient with repaired tetralogy of Fallot (TOF) sometimes require cardiac implantable electronic devices (CIED) for tachy/bradyarrhythmias. There are no population-based studies of CIED-related outcomes in the adult TOF population. We reviewed the Nationwide/National Inpatient Sample to determine trends in CIED-related admissions in adults with TOF repair. This is a retrospective review of the Nationwide/National Inpatient Sample database from January 1, 2000 to December 31, 2014. There were 18,353 admissions in adults with TOF diagnosis, and of these, CIED were implanted in 792 (4.3%) admissions (CIED-related admissions). Of these 792 CIED-related admissions, pacemakers were implanted in 242 (30.7%) yielding an incidence of 1.3% and implantable cardioverter-defibrillators were implanted in 550 (69.4%) yielding an incidence of 3.0%. In-hospital mortality occurred in 14 (1.8%) of the CIED-related admissions. The mean hospital length of stay was 7.7 ± 1.3 days and inflation-adjusted hospitalization cost was $141,860 ± $127,516. In 5-year intervals (2000 to 2004, 2005 to 2009, and 2010 to 2014), there was a temporal increase in the incidence of CIED-related admissions (3.7% vs 4.4% vs 4.9%, p = 0.006). There was a similar trend in the age at the time of implantation (37.7 ± 14.2 vs 38.2 ± 13.1 vs 39.0 ± 14.5 years, p < 0.001) and Charlson Comorbidity Index (1.1 ± 1.4 vs 1.4 ± 1.8 vs 1.3 ± 1.7, p < 0.001). In conclusion, the incidence of CIED-related admissions was 4.3% and increased over time. Further studies are required to determine if the observed temporal increase in incidence of CIED implantations (particularly implantable cardioverter-defibrillators) is associated with a concomitant increase in incidence of aborted sudden cardiac death.
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Affiliation(s)
- Alexander C Egbe
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota.
| | | | - Emmanuel Akintoye
- Division of Cardiovascular Medicine, University of Iowa Hospitals and Clinic, Iowa
| | - Abhishek Deshmukh
- Department of Cardiovascular Medicine, Mayo Clinic Rochester, Minnesota
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Bauser-Heaton H, Ma M, McElhinney DB, Goodyer WR, Zhang Y, Chan FP, Asija R, Shek J, Wise-Faberowski L, Hanley FL. Outcomes After Aortopulmonary Window for Hypoplastic Pulmonary Arteries and Dual-Supply Collaterals. Ann Thorac Surg 2019; 108:820-827. [PMID: 30980823 DOI: 10.1016/j.athoracsur.2019.03.022] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2019] [Revised: 03/01/2019] [Accepted: 03/04/2019] [Indexed: 12/19/2022]
Abstract
BACKGROUND Our institutional approach to tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs) emphasizes early unifocalization and complete repair (CR). In the small subset of patients with dual-supply MAPCAs and confluent but hypoplastic central pulmonary arteries (PAs), our surgical approach is early creation of an aortopulmonary window (APW) to promote PA growth. Factors associated with successful progression to CR and mid-term outcomes have not been assessed. METHODS Clinical data were reviewed. PA diameters were measured offline from angiograms prior to APW and on follow-up catheterization >1 month after APW but prior to any additional surgical interventions. RESULTS From November 2001 to March 2018, 352 patients with tetralogy of Fallot/MAPCAs underwent initial surgery at our center, 40 of whom had a simple APW with or without ligation of MAPCAs as the first procedure (median age, 1.4 months). All PA diameters increased significantly on follow-up angiography. Ultimately, 35 patients underwent CR after APW. Nine of these patients (26%) underwent intermediate palliative operation between 5 and 39 months (median, 8 months) after APW. There were no early deaths. The cumulative incidence of CR was 65% 1 year post-APW and 87% at 3 years. Repaired patients were followed for a median of 4.2 years after repair; the median PA:aortic pressure ratio was 0.39 (range, 0.22 to 0.74). CONCLUSIONS Most patients with tetralogy of Fallot/MAPCAs and hypoplastic but normally arborizing PAs and dual-supply MAPCAs are able to undergo CR with low right ventricular pressure after APW early in life. Long-term outcomes were good, with acceptable PA pressures in most patients.
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Affiliation(s)
- Holly Bauser-Heaton
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Michael Ma
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Doff B McElhinney
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California.
| | - William R Goodyer
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Yulin Zhang
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Frandics P Chan
- Department of Radiology, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Ritu Asija
- Department of Pediatrics, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Jennifer Shek
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Lisa Wise-Faberowski
- Department of Anesthesia, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Heart Center Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
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Vaikunth SS, Bauser-Heaton H, Lui GK, Wise-Faberowski L, Chan FP, Asija R, Hanley FL, McElhinney DB. Repair of Untreated Older Patients With Tetralogy of Fallot With Major Aortopulmonary Collaterals. Ann Thorac Surg 2018; 107:1218-1224. [PMID: 30550802 DOI: 10.1016/j.athoracsur.2018.11.016] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/18/2018] [Accepted: 11/05/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Our programmatic approach to tetralogy of Fallot with major aortopulmonary collaterals emphasizes single-stage unifocalization with complete intracardiac repair during infancy. Little is known about suitability for complete repair in patients beyond infancy. We sought to analyze outcomes of our approach in older patients with previously untreated tetralogy of Fallot with major aortopulmonary collaterals. METHODS Any patient with this lesion not treated before 2 years of age referred to our center from 2002 to 2017 met inclusion criteria. RESULTS Of 33 patients, 32 were out-of-state (64% international) referrals, and 33% (n = 11) were older than 9 years, had polycythemia, or at least 1 high pressure collateral (>25 mm Hg). Complete repair was achieved in 94% (n = 31) of patients, 82% (n = 27) in one stage and 12% (n = 4) after unifocalization to a central shunt. The median right ventricular-to-aortic pressure ratio was 0.31 after the operation and 0.37 at follow-up. At a median of 4.8 years after repair, 9 patients (19%) underwent reintervention, including 5 conduit and 7 branch pulmonary artery interventions. Three patients also underwent aortic valve replacement. CONCLUSIONS In this selected cohort of older patients with previously unoperated tetralogy of Fallot with major aortopulmonary collaterals, outcomes were comparable with infants undergoing treatment according to our approach. These findings support the notion that patients who are either born in low-resource settings or present to health care providers beyond infancy should be considered candidates and evaluated for complete repair.
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Affiliation(s)
- Sumeet S Vaikunth
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California.
| | - Holly Bauser-Heaton
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - George K Lui
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California; Department of Medicine, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Lisa Wise-Faberowski
- Department of Anesthesiology, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Frandics P Chan
- Department of Radiology, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Ritu Asija
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Frank L Hanley
- Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
| | - Doff B McElhinney
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California; Department of Cardiothoracic Surgery, Lucile Packard Children's Hospital Stanford, Clinical and Translational Research Program, Stanford University School of Medicine, Palo Alto, California
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13
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Sandoval N, Carreño M, Novick WM, Agarwal R, Ahmed I, Balachandran R, Balestrini M, Cherian KM, Croti U, Du X, Gauvreau K, Cam Giang DT, Shastri R, Jenkins KJ. Tetralogy of Fallot Repair in Developing Countries: International Quality Improvement Collaborative. Ann Thorac Surg 2018; 106:1446-1451. [PMID: 29969617 DOI: 10.1016/j.athoracsur.2018.05.080] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2018] [Revised: 05/05/2018] [Accepted: 05/29/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Isolated reports from low- and middle-income countries (LMICs) for surgical results in tetralogy of Fallot (TOF) are available. The International Quality Improvement Collaborative for Congenital Heart Disease (IQIC) seeks to improve surgical results promoting reductions in infection and mortality in LMICs. METHODS All cases of TOF in the IQIC database performed between 2010 and 2014 at 32 centers in 20 LMICs were included. Excluded from the analysis were TOF with any associated lesions. A logistic regression analysis was performed to identify risk factors for in-hospital mortality after surgery for TOF. RESULTS A total of 2,164 patients were identified. There were 1,839 initial primary repairs, 200 with initial systemic-to-pulmonary artery shunt, and 125 underwent secondary repair after initial palliation. Overall mortality was 3.6% (78 of 2,164), initial primary repair was 3.3% (60 of 1,839), initial systemic-to-pulmonary artery shunt was 8.0% (16 of 200), and secondary repair was 1.6% (2 of 125; p = 0.003). Major infections occurred in 5.9% (128 of 2,164) of the entire cohort. Risk factors for death after the initial primary repair were oxygen saturation less than 90% and weight/body mass index for age below the fifth percentile (p < 0.001). The initial primary repair occurred after age 1 year in 54% (991 of 1,839). Older age at initial primary repair was not a risk factor for death (p = 0.21). CONCLUSIONS TOF patients are often operated on after age 1 year in LMICs. Unlike in developed countries, older age is not a risk factor for death. Nutritional and hypoxemic status were associated with higher mortality and infection. This information fills a critical knowledge gap for surgery in LMIC.
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Affiliation(s)
- Nestor Sandoval
- Department of Cardiac Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Congenital Heart Institute, Universidad del Rosario, Bogotá, Colombia.
| | - Marisol Carreño
- Department of Cardiac Surgery, Fundación Cardioinfantil-Instituto de Cardiología, Congenital Heart Institute, Universidad del Rosario, Bogotá, Colombia
| | - William M Novick
- William Novick Global Cardiac Alliance, Memphis, Tennessee; Department of Surgery, University of Tennessee Health Science Center, Memphis, Tennessee
| | - Ravi Agarwal
- Department of Cardiac Surgery, Madras Medical Mission, Chennai, India
| | - Iftikhar Ahmed
- Department of Anesthesia, Armed Forces Institute of Cardiology, National Institute of Heart Disease, Rawalpindi, Pakistan
| | - Rakhi Balachandran
- Department of Cardiac Anesthesia and Pediatric Cardiac Critical Care, Amrita Institute of Medical Science, Kochi, India
| | - Maria Balestrini
- Department of Pediatric Cardiac Intensive Care, Hospital Garrahan, Buenos Aires, Argentina
| | - K M Cherian
- Department of Cardiac Surgery, Frontier Lifeline Hospital, Chennai, India
| | - Ulisses Croti
- Department of Pediatric Cardiovascular Surgery, Hospital da Criança e Maternidade, Sao Jose do Rio Preto, Brazil
| | - Xinwei Du
- Department of Cardiothoracic Surgery, Shanghai Children's Medical Center, Shanghai, China
| | - Kimberlee Gauvreau
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
| | - Do Thi Cam Giang
- Department of Pediatric Cardiology, Nhi Dong 1, Ho Chi Minh City, Vietnam
| | - Ramkinkar Shastri
- Department of Pediatric Cardiac Surgery, Star Hospital, Hyderabad, India
| | - Kathy J Jenkins
- Department of Cardiology, Boston Children's Hospital, Boston, Massachusetts
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14
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Zhao Y, Edington S, Fleenor J, Sinkovskaya E, Porche L, Abuhamad A. Fetal cardiac axis in tetralogy of Fallot: associations with prenatal findings, genetic anomalies and postnatal outcome. Ultrasound Obstet Gynecol 2017; 50:58-62. [PMID: 27302537 DOI: 10.1002/uog.15998] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Revised: 06/08/2016] [Accepted: 06/10/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To compare prenatal findings, associated genetic anomalies and postnatal outcome in fetuses with tetralogy of Fallot (TOF) with normal cardiac axis (CAx) and those with abnormal CAx. METHODS In this retrospective cohort study, 85 cases diagnosed with TOF by prenatal ultrasound at our clinic between 2005 and 2015 were reviewed. Follow-up ultrasound and postnatal outcome were available for 68 cases. One case complicated with absent pulmonary valve syndrome and a further seven cases diagnosed postnatally with anomalies other than TOF were excluded from the study. The remaining 60 cases of postnatally confirmed TOF were divided according to CAx into two groups: those with normal CAx (n = 33) and those with abnormal CAx (n = 27). CAx was defined as the angle between the interventricular septum and midline of the fetal thorax at the level of the four-chamber view. CAx > 65° or < 25° was considered abnormal. Prenatal sonographic findings, associated genetic anomalies and postnatal outcome were compared between the two groups. RESULTS Fetuses with TOF and abnormal CAx were more likely to have pulmonary atresia (40.7% vs 15.2%; P = 0.026) and right-sided aortic arch (48.1% vs 21.2%; P = 0.028) than those with normal CAx. Postnatal death occurred in 30.4% of infants with abnormal CAx vs 6.5% with normal CAx (P = 0.028). Incidence of tested genetic anomalies was similar between the two groups. CONCLUSION In fetuses with TOF, abnormal CAx is associated with the presence of pulmonary atresia, right-sided aortic arch and a higher risk of postnatal death. Copyright © 2016 ISUOG. Published by John Wiley & Sons Ltd.
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Affiliation(s)
- Y Zhao
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - S Edington
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - J Fleenor
- Department of Pediatrics, Eastern Virginia Medical School, Norfolk, VA, USA
| | - E Sinkovskaya
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - L Porche
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
| | - A Abuhamad
- Department of Obstetrics and Gynecology, Eastern Virginia Medical School, Norfolk, VA, USA
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15
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Xie D, Wang H, Liu Z, Fang J, Yang T, Zhou S, Wang A, Qin J, Xiong L. Perinatal outcomes and congenital heart defect prognosis in 53313 non-selected perinatal infants. PLoS One 2017; 12:e0177229. [PMID: 28591192 PMCID: PMC5462529 DOI: 10.1371/journal.pone.0177229] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2016] [Accepted: 04/24/2017] [Indexed: 11/25/2022] Open
Abstract
Objective To evaluate perinatal outcomes and congenital heart defect (CHD) prognosis in a non-selected population. Methods The population-based surveillance data used in this assessment of CHDs were based on birth defect surveillance data collected from 2010–2012 in Liuyang City, China. Infants living with CHDs were followed up for 5 years to determine their prognosis. Prevalence, prenatal diagnosis, perinatal outcomes, and total and type-specific prognosis data were assessed using SPSS 18.0. Results In total, 190 CHD cases were identified among the 53313 included perinatal infants (PIs), indicating a CHD prevalence of 35.64 per 10000 PIs in this non-selected population. The five most frequently identified types of CHDs were ventricular septal defects (VSDs, 38.95%), atrial septal defects (ASDs, 15.79%), cardiomegaly (7.89%), tetralogy of Fallot (TOF, 5.79%), and atrioventricular septal defects (AVSDs, 5.26%). Of the 190 CHD cases, 110 (57.89%) were diagnosed prenatally, 30 (15.79%) were diagnosed with associated malformations, and 69 (36.32%) resulted in termination of pregnancy (TOP). Moreover, 15 (7.89%) PIs died within 7 days after delivery, and 42 (22.10%) died within 1 year. In contrast, 79 (41.58%) were still alive after 5 years. When TOP cases were included, the 5-year survival rate of PIs with prenatally detected CHDs was lower than that of PIs with postnatally detected CHDs (25.45% vs. 63.75%). The CHD subtype associated with the highest rate of infant (less than 1 year old) mortality was transposition of the great arteries (100%). The subtypes associated with higher 5-year survival rates were patent ductus arteriosus (80%), ASD (63.33%), VSD (52.70%) and AVSD (50%). Conclusions The rates of prenatal CHD detection and TOP were high in this study population, and the 5-year survival rate of PIs with CHDs was low. The government should strengthen efforts to educate pediatricians regarding this issue and provide financial assistance to improve the prognosis of infants living with CHDs, especially during the first year of life.
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MESH Headings
- Abnormalities, Multiple
- Cardiomegaly/diagnosis
- Cardiomegaly/mortality
- Cardiomegaly/physiopathology
- Female
- Heart Defects, Congenital/classification
- Heart Defects, Congenital/diagnosis
- Heart Defects, Congenital/mortality
- Heart Defects, Congenital/physiopathology
- Heart Septal Defects, Atrial/diagnosis
- Heart Septal Defects, Atrial/mortality
- Heart Septal Defects, Atrial/physiopathology
- Heart Septal Defects, Ventricular/diagnosis
- Heart Septal Defects, Ventricular/mortality
- Heart Septal Defects, Ventricular/physiopathology
- Humans
- Infant
- Infant, Newborn
- Male
- Perinatal Mortality
- Pregnancy
- Prenatal Diagnosis
- Prognosis
- Tetralogy of Fallot/diagnosis
- Tetralogy of Fallot/mortality
- Tetralogy of Fallot/physiopathology
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Affiliation(s)
- Donghua Xie
- Department of Information Management, Maternal and Children’s Hospital of Hunan Province, Changsha, Hunan, China
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, P.R. of China
| | - Hua Wang
- Department of Health Care Management, Maternal and Children’s Hospital of Hunan Province, Changsha, Hunan, China
- * E-mail: (HW); (ZL)
| | - Zhiyu Liu
- Department of Information Management, Maternal and Children’s Hospital of Hunan Province, Changsha, Hunan, China
- * E-mail: (HW); (ZL)
| | - Junqun Fang
- Department of Health Care Management, Maternal and Children’s Hospital of Hunan Province, Changsha, Hunan, China
| | - Tubao Yang
- Department of Epidemiology and Health Statistics, School of Public Health, Central South University, Changsha, Hunan, P.R. of China
| | - Shujin Zhou
- Department of Health Care Management, Maternal and Children’s Hospital of Liuyang City, Hunan, China
| | - Aihua Wang
- Department of Information Management, Maternal and Children’s Hospital of Hunan Province, Changsha, Hunan, China
| | - Jiabi Qin
- Department of Health Care Management, Maternal and Children’s Hospital of Hunan Province, Changsha, Hunan, China
| | - Lili Xiong
- Department of Information Management, Maternal and Children’s Hospital of Hunan Province, Changsha, Hunan, China
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Kapoor PM, Narula J, Chowdhury UK, Kiran U, Taneja S. Serum albumin perturbations in cyanotics after cardiac surgery: Patterns and predictions. Ann Card Anaesth 2016; 19:300-5. [PMID: 27052073 PMCID: PMC4900356 DOI: 10.4103/0971-9784.179633] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2016] [Accepted: 04/14/2016] [Indexed: 01/13/2023] Open
Abstract
INTRODUCTION Hypoalbuminemia is a well-recognized predictor of general surgical risk and frequently occurs in patients with cyanotic congenital heart disease (CCHD). Moreover, cardiopulmonary bypass (CPB)-induced an inflammatory response, and the overall surgical stress can effect albumin concentration greatly. The objective of his study was to track CPB-induced changes in albumin concentration in patients with CCHD and to determine the effect of hypoalbuminemia on postoperative outcomes. MATERIALS AND METHODS Prospective observational study conducted in 150 patients, Group 1 ≤18 years (n = 75) and Group 2 >18 years (n = 75) of age. Albumin levels were measured preoperatively (T1), after termination of CPB (T2) and 48 h post-CPB (T3). Primary parameters (mortality, duration of postoperative ventilation, duration of inotropes and duration of Intensive Care Unit [ICU] stay) and secondary parameters (urine output, oliguria, arrhythmias, and hemodynamic parameters) were recorded. RESULTS The albumin levels in Group 1 at T1, T2, and T3 were 3.8 ± 0.48, 3.2 ± 0.45 and 2.6 ± 0.71 mg/dL; and in Group 2 were 3.7 ± 0.50, 3.2 ± 0.49 and 2.7 ± 0.62 mg/dL respectively. All patients showed a significant decrease in albumin concentration 48 h after surgery (P < 0.01). Analysis between the groups, however, showed no statistical difference. Eleven patients expired during the study period, and nonsurvivors showed significantly lower serum albumin concentration 48 h after surgery 2.3 ± 0.62 mg/dL versus 3.7 ± 0.56 mg/dL in the survivors (P < 0.05). Receiver operating characteristic curve showed that a baseline albumin cut-off value of 3.3 g/dL predicts mortality with a positive predictive value 47.6% and a negative predictive value of 99.2% (P < 0.05). A strong correlation was seen between albumin levels at 48 h with duration of CPB (r2 = 0.6321), ICU stay (r2 = 0.7447) and incidence of oliguria (r2 = 0.8803). CONCLUSIONS The study demonstrated similar fall in albumin concentration in cyanotic patients (both adult and pediatric) in response to CPB. Low preoperative serum albumin concentrations (<3.3 g/dL) can be used to identify and prognosticate subset of cyanotics predisposed to additional surgical risk.
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Affiliation(s)
- Poonam Malhotra Kapoor
- Department of Cardiac Anaesthesiology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Jitin Narula
- Department of Cardiac Anaesthesiology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Ujjwal Kumar Chowdhury
- Department of Cardiothoracic and Vascular Surgery, All India Institute of Medical Sciences, New Delhi, India
| | - Usha Kiran
- Department of Cardiac Anaesthesiology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
| | - Sameer Taneja
- Department of Cardiac Anaesthesiology, Cardiothoracic and Neurosciences Centre, All India Institute of Medical Sciences, New Delhi, India
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Castañeda AR, Rosenthal A. Persistent abnormalities after repair of congenital heart defects. Ventricular septal defect and tetralogy of Fallot. Adv Cardiol 2015; 20:110-6. [PMID: 848382 DOI: 10.1159/000399859] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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Khairy P, Dore A, Poirier N, Marcotte F, Ibrahim R, Mongeon FP, Mercier LA. Risk stratification in surgically repaired tetralogy of Fallot. Expert Rev Cardiovasc Ther 2014; 7:755-62. [PMID: 19589112 DOI: 10.1586/erc.09.38] [Citation(s) in RCA: 65] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Affiliation(s)
- Paul Khairy
- Adult Congenital Heart Center, Montreal Heart Institute, QC, Canada.
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Abstract
OBJECTIVE To evaluate the scale and clinical importance of loss to follow-up of past patients with serious congenital heart disease, using a common malformation as an example. To better understand the antecedents of loss to specialist follow-up and patients' attitudes to returning. DESIGN Cohort study using NHS number functionality. Content and thematic analysis of telephone interviews of subset contacted after loss to follow-up. PATIENTS, INTERVENTION AND SETTING: Longitudinal follow-up of complete consecutive list of all 1085 UK patients with repair of tetralogy of Fallot from single institution 1964-2009. MAIN OUTCOME MEASURES Survival, freedom from late pulmonary valve replacement, loss to specialist follow-up, shortfall in late surgical revisions related to loss to follow-up. Patients' narrative about loss to follow-up. RESULTS 216 (24%) of patients known to be currently alive appear not to be registered with specialist clinics; some are seen in general cardiology clinics. Their median age is 32 years and median duration of loss to follow-up is 22 years; most had been lost before Adult Congenital services had been consolidated in their present form. 48% of the late deaths to date have occurred in patients not under specialist follow-up. None of those lost to specialist follow-up has had secondary pulmonary valve replacement while 188 patients under specialist care have. Patients lost to specialist follow-up who were contacted by telephone had no knowledge of its availability. CONCLUSIONS Loss to specialist follow-up, typically originating many years ago, impacts patient management.
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Affiliation(s)
- Jo Wray
- Department of Cardiology, Great Ormond Street Hospital, London, UK.
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Kim SJ, Park SA, Song J, Shim WS, Choi EY, Lee SY. The role of transesophageal echocardiography during surgery for patients with tetralogy of Fallot. Pediatr Cardiol 2013; 34:240-4. [PMID: 22790360 DOI: 10.1007/s00246-012-0423-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 06/22/2012] [Indexed: 11/30/2022]
Abstract
Routine use of intraoperative transesophageal echocardiography (TEE) is a safe monitoring and diagnostic method during pediatric congenital cardiac surgery. However, the question of whether intraoperative TEE is accurate and cost effective for patients with tetralogy of Fallot (TOF) has not been raised. This study aimed to analyze the cost-benefit of routine TEE during the repair of TOF. The medical records, including TEE results, for patients who underwent correction of TOF between January 1997 and June 2007 were reviewed and retrospectively analyzed. Intraoperative TEE was performed for 340 patients (85 %). Residual problems were detected in 17.9 % (61/340), and a return to bypass was needed for 10 % (34/340) of the patients. The degree of agreement between the intraoperative TEE and early postoperative transthoracic echocardiography (TTE) was relatively high. Surgeons with less surgical experience more frequently used intraoperative TEE (p = 0.007) and performed repeat bypass surgery at a higher rate (p = 0.00). Even relatively unskilled surgeons might be able to achieve surgical outcomes similar to those of experienced surgeons using intraoperative TEE. By avoiding late surgical revision, the possible cost savings were estimated to be 1,726,000 Korean won (US$1,489) per TEE examination. Intraoperative TEE can be used as a tool for surgeons in making decisions in the operating room. In addition, intraoperative TEE decreased the frequency of reoperations and postoperative interventions. The results of this study demonstrate that routine intraoperative TEE during repair of TOF was both clinically beneficial and cost effective.
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Affiliation(s)
- Soo-Jin Kim
- Department of Pediatric Cardiology, School of Medicine, Konkuk University, 4-12 Hwayng-dong, Gwangjin-gu, Seoul 143-729, Republic of Korea.
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Zheng DW, Shao GF, Feng Q, Ni YM. Long-term outcome of correction of tetralogy of Fallot in 56 adult patients. Chin Med J (Engl) 2013; 126:3675-3679. [PMID: 24112162] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/02/2023] Open
Abstract
BACKGROUND Although most patients with tetralogy of Fallot undergo radical repair during infancy and childhood, patients that remain undiagnosed and untreated until adulthood can still be treated. This study aimed to evaluate longterm outcomes of adult patients with tetralogy of Fallot who were treated surgically, and to determine the predictors of postoperative pulmonary regurgitation. METHODS Fifty-six adult patients underwent complete surgical repair. Forty-three patients (76.8%) required a transannular patch. Systolic, diastolic, and mean pressure in the main pulmonary artery were measured after repair. RESULTS The early mortality rate was 3.6%. The 16-year survival rate was (84.4 ± 11.5)%. Late echocardiography revealed 41 patients with transannular patch who had pulmonary regurgitation, consisting of mild pulmonary regurgitation in 28 patients, moderate in eight, and severe regurgitation in five patients. In addition, there was right ventricular outflow tract stenosis in nine patients, moderate/severe tricuspid valve regurgitation in seven, and residual ventricular septal defect in five. Logistic regression analysis demonstrated that the mean pulmonary pressure measured just after repair predicted late pulmonary regurgitation. CONCLUSIONS The long-term survival of surgically treated adult patients with tetralogy of Fallot is acceptable. The mean pressure >20 mmHg in the main pulmonary artery measured right after surgical repair may be a feasible reference to time the reconstruction of the pulmonary valve.
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Affiliation(s)
- Da-wei Zheng
- Department of Cardiothoracic Surgery, the First Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, Zhejiang 310003, China; Department of Cardiothoracic Surgery, Ningbo Medical Centre Lihuili Hospital, Ningbo, Zhejiang 315041, China
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Valente AM, Gauvreau K, Assenza GE, Babu-Narayan SV, Evans SP, Gatzoulis M, Groenink M, Inuzuka R, Kilner PJ, Koyak Z, Landzberg MJ, Mulder B, Powell AJ, Wald R, Geva T. Rationale and design of an International Multicenter Registry of patients with repaired tetralogy of Fallot to define risk factors for late adverse outcomes: the INDICATOR cohort. Pediatr Cardiol 2013; 34:95-104. [PMID: 22669402 DOI: 10.1007/s00246-012-0394-5] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Accepted: 05/10/2012] [Indexed: 11/30/2022]
Abstract
Although early survival after tetralogy of Fallot (TOF) repair in the modern era is excellent, studies on late outcomes have shown increasing rates of mortality and morbidity. Despite multiple publications on factors associated with late complications, risk factors for major outcomes (death and sustained ventricular tachycardia [VT]) remain poorly defined. Consequently, the International Multicenter TOF Registry (INDICATOR) was established. This article describes the development, structure, and goals of this registry and characterizes the initial cohort derived from four large congenital heart centers in the United States, Canada, and Europe. A data coordinating center with a core cardiac magnetic resonance (CMR) laboratory and statistical core was established. Subjects with repaired TOF who had CMR imaging performed between 1997 and 2010 and ≥ 1 year follow-up were included. Clinical end points were death and sustained VT. Demographic, electrophysiologic, exercise, and outcome data were collected. A total of 873 subjects fulfilled inclusion criteria (median age at repair 2.9 years and at CMR imaging 22.8 years). Of these, 9 % had QRS duration >180 ms on electrocardiogram (ECG). On CMR imaging, 38 % had severe right-ventricular (RV) dilatation (≥ 160 mL/m(2)), and 6 % had severe RV dysfunction (ejection fraction < 35 %). Of the 551 subjects with exercise testing available, 28 % had severely decreased exercise capacity with <50 % predicted peak oxygen consumption. The INDICATOR cohort allows robust statistical analysis to evaluate major clinical outcomes in patients with repaired TOF. Continued follow-up and further expansion of the registry may provide new insights into innovative therapeutic strategies to improve late outcomes.
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Affiliation(s)
- Anne Marie Valente
- Department of Cardiology, Boston Children's Hospital and Department of Pediatrics, Harvard Medical School, Boston, MA 02115, USA
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Urso S, Rega F, Gewillig M, Eyskens B, Heying R, Daenen W, Meyns B. Evolution of the Z-score in size-reduced bicuspid homografts. J Heart Valve Dis 2012; 21:521-526. [PMID: 22953682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY Human homografts are frequently used to establish an anatomic continuity between the right ventricular outflow tract (RVOT) and the pulmonary artery. Their limited availability, especially in small sizes, has encouraged the use of alternative strategies, such as size-reduced bicuspid homografts. The study aim was to analyze the follow up of patients who had received a standard tricuspid or size-reduced bicuspid homograft in the RVOT position, and to investigate modifications of the patients' Z-scores over the years. METHODS A consecutive series of 107 patients aged < or = 16 years, who underwent RVOT repair between 1989 and 2010 to treat tetralogy of Fallot (ToF), was retrospectively reviewed. Of these patients, 17 received a size-reduced bicuspid pulmonary homograft, while 90 received a standard tricuspid homograft. The mean follow up periods were 10.5 years (range: 0.02-21.4 years) for the whole study population, and 11.8 years and 3.4 years, respectively, for the tricuspid and size-reduced bicuspid homograft groups. RESULTS Freedom from mortality at 10 years was 95 +/- 3%. During the observation period, 27 patients (31%) in the tricuspid homograft group and two (125) in the size-reduced bicuspid group presented with graft failure. According to the multivariable analysis, the only independent predictor of graft failure was patient age (hazards ratio 0.86). The 17 patients who had received a size-reduced bicuspid homograft were then age-matched to an equal-sized population of tricuspid homograft patients. A comparative analysis of the time-weighted average of the Z-scores for these tricuspid and size-reduced bicuspid homograft subgroups during the follow up period failed to identify any statistical difference (p = 0.5). CONCLUSION In terms of Z-score evolution, size-reduced bicuspid homografts offer results which are comparable to those achieved with tricuspid homografts.
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Affiliation(s)
- Stefano Urso
- Department of Cardiac Surgery, University Hospital Gasthuisberg, Leuven, Belgium.
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Malec E, Malec K, Januszewska K. [Patients after surgical repair of tetralogy of Fallot. Treatment or correction]. Kardiol Pol 2012; 70:75-79. [PMID: 22267433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023]
Affiliation(s)
- Edward Malec
- Department of Cardiac Surgery, Ludwig Maximilian University Munich, Niemcy
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Hashemzadeh K, Hashemzadeh S. Early and late results of total correction of tetralogy of Fallot. Acta Med Iran 2010; 48:117-122. [PMID: 21133005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/30/2023] Open
Abstract
The purpose of this study was to evaluate the early and late outcome after total correction of tetralogy of fallot (TOF) in 101 consecutive patients with a mean age of 8.23 +/- 4.90 years underwent repair of surgery at one institution between 1995 and 2006. Forty two patients had initial palliative operations. A transannular patch was inserted in 60 (58.5%) patients. Risk factors for operative mortality were analyzed. Follow-up was obtained from clinical appointments and telephone questionnaires. The operative mortality was 6.9%. Aortic cross-clamp time more than 90 minutes (P<0.01) and cardiopulmonary bypass time more than 120 minute (P<0.01), affected operative mortality, whereas previous palliative procedure, hematocrit level, and use of transannular patch did not. Mean follow-up is 34.08 +/- 31.09 months (range, 1 month to 120 months). Actuarial survival is 91% alive 10 years after total correction. On Postoperative echocardiography, 22 patients had mild pulmonary regurgitation, 19 had a right ventricular outflow tract gradient more than 50 mmHg, and 10 had a small residual ventricular septal defect. There were two late deaths. Late sudden death from cardiac causes occurred in one patients. Total correction of TOF can have low operative mortality and provide excellent long-term survival. This experience suggests that the key factor in the total correction of TOF is to correct the pathology completely, to protect the myocardium, and to manage the complication properly.
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Affiliation(s)
- Khosrow Hashemzadeh
- Department of Cardiovascular Surgery, Cardiovascular Research Center, Shahid Madani Hospital, Tabriz University of Medical Sciences, Tabriz, Iran.
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Knuf M, Kuroczyński W, Schone F, Martin C, Huth R, Rhein MV, Vahl CF, Kampann C. Significance of patient categorization for perioperative management of children with tetralogy of Fallot, with special regard to co-existing malformations. Cardiol J 2010; 17:20-28. [PMID: 20104453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023] Open
Abstract
BACKGROUND The aim of our study was to facilitate perioperative calculation of potential risk factors on the outcome of corrective surgery for children with tetralogy of Fallot. METHODS The medical records of 81 (44 female and 37 male) out of a total of 87 patients undergoing complete surgical repair of tetralogy of Fallot between 1988 and 2004 at the Children's Hospital of the Johannes Gutenberg University of Mainz were reviewed. PATIENTS were divided into four categories, depending on the severity of pulmonary stenosis and cyanosis, as well as on the type of pulmonary circulation. RESULTS Additional malformations did not affect mortality rates, but did directly affect the number of pleural effusions, time of epinephrine administration, duration of surgery, bypass, and ischemia, as well as length of hospitalization and intensive care unit treatment. In contrast to longer periods of extracorporeal circulation and ischemia during surgery, which are directly related not only to more complex anatomical situations but also to higher mortality and complication rates, the much-debated question of age at surgery had no influence either on the surgical approach itself or on the post-operative outcome. CONCLUSIONS Our patient categorization, and evaluation of potential pre-operative risk factors and intraoperative parameters, should prove useful for the future planning and execution of therapeutic procedures in institutions around the world.
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Affiliation(s)
- Markus Knuf
- University of Mainz, Children's Hospital, Mainz, Germany
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Book WM, Kogon B, McConnell ME. Letter by Book et al regarding article, "pulmonary valve replacement in tetralogy of Fallot: impact on survival and ventricular tachycardia". Circulation 2009; 120:e79; author reply e80. [PMID: 19738148 DOI: 10.1161/circulationaha.109.851964] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Suciu H, Deac R, Tilea I, Neagoe R, Jerzicska E, Făgărăşan A. [Tetralogy of Fallot--new appearance of an old technique]. Rev Med Chir Soc Med Nat Iasi 2009; 113:459-465. [PMID: 21495352] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
Abstract
UNLABELLED Tetralogy of Fallot represents one of the most frequent congenital heart disease in medical practice and a "corner stone" of any paediatric surgical team due to great anatomic and functional variability and clinical aspects. This paper presents a retrospective study of surgical experience in patients with tetralogy of Fallot admitted in Paediatric Cardiovascular Centre of Târgu Mureş, Romania, between 2005, October to 2009, January. METHOD There where retrospectively studied medical records of patients who undergo a surgical procedure: age, morphologic diagnosis, symptoms and type of surgical procedure, intraoperative data, postoperative follow-up and complications. RESULTS In this period 110 cases of tetralogy of Fallot were operated, 81 total surgical repair (54 primary and 27 secondary procedures); also there were performed 29 "palliative" procedures: systemic/pulmonary shunts (eg. Blalock-Taussig). No intraoperative deaths were recorded; the percentage of in-hospital mortality was 1.8%. CONCLUSIONS It's ideal to perform total primary repair of tetralogy of Fallot, especially in the first year of life; extreme cases (severe hypoplasic pulmonary arteries, emergency cases) benefit from "palliative" procedures. Surgical repair of Fallot tetralogy can be performed, with good results in specialised paediatric cardiac surgery centres. This paper represents the first Romanian clinical study on a large number of patients with tetralogy of Fallot surgically treated.
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Affiliation(s)
- H Suciu
- Institutul de Urgenţă pentru Boli Cardiovasculare si Transplant, Clinica de Chirurgie Cardiovasculară, Universitatea de Medicină si Farmacie Târgu Mureş
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Abstract
Tetralogy of Fallot is a congenital cardiac malformation that consists of an interventricular communication, also known as a ventricular septal defect, obstruction of the right ventricular outflow tract, override of the ventricular septum by the aortic root, and right ventricular hypertrophy. This combination of lesions occurs in 3 of every 10,000 live births, and accounts for 7-10% of all congenital cardiac malformations. Patients nowadays usually present as neonates, with cyanosis of varying intensity based on the degree of obstruction to flow of blood to the lungs. The aetiology is multifactorial, but reported associations include untreated maternal diabetes, phenylketonuria, and intake of retinoic acid. Associated chromosomal anomalies can include trisomies 21, 18, and 13, but recent experience points to the much more frequent association of microdeletions of chromosome 22. The risk of recurrence in families is 3%. Useful diagnostic tests are the chest radiograph, electrocardiogram, and echocardiogram. The echocardiogram establishes the definitive diagnosis, and usually provides sufficient information for planning of treatment, which is surgical. Approximately half of patients are now diagnosed antenatally. Differential diagnosis includes primary pulmonary causes of cyanosis, along with other cyanotic heart lesions, such as critical pulmonary stenosis and transposed arterial trunks. Neonates who present with ductal-dependent flow to the lungs will receive prostaglandins to maintain ductal patency until surgical intervention is performed. Initial intervention may be palliative, such as surgical creation of a systemic-to-pulmonary arterial shunt, but the trend in centres of excellence is increasingly towards neonatal complete repair. Centres that undertake neonatal palliation will perform the complete repair at the age of 4 to 6 months. Follow-up in patients born 30 years ago shows a rate of survival greater than 85%. Chronic issues that now face such adults include pulmonary regurgitation, recurrence of pulmonary stenosis, and ventricular arrhythmias. As the strategies for surgical and medical management have progressed, the morbidity and mortality of those born with tetralogy of Fallot in the current era is expected to be significantly improved.
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Affiliation(s)
- Frederique Bailliard
- North Carolina Children's Heart Center, Department of Pediatrics, University of North Carolina at Chapel Hill, USA
| | - Robert H Anderson
- North Carolina Children's Heart Center, Department of Pediatrics, University of North Carolina at Chapel Hill, USA
- Division of Pediatric Cardiology, Medical University of South Carolina, Charleston, South Carolina, USA
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Karalius R. [Influence of reconstruction of right ventricle outflow tract to the results of radical correction of tetralogy of Fallot]. Medicina (Kaunas) 2008; 38 Suppl 2:194-7. [PMID: 12560659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 02/28/2023]
Abstract
UNLABELLED We wanted to compare results of different methods of correction of right ventricle outflow tract (RVOT) obstruction. In our clinic 259 radical corrections of tetralogy of Fallot were performed from 1984 till 2002. Age of patients from 1 and a half-year to 55 years; 42 from them were children till 3 years age. One hundred twenty nine were primary corrections and 130 after palliative procedure. We divided patients into 6 groups. First group 83 cases - RV reconstruction with pericardial patch. II(nd) group 27 RV reconstruction and commisurotomy of PA. III(rd) group 97 cases RVOT reconstruction with transannular patch. IV(th) group - 30 cases. RVOT reconstruction with monocusp patch. V(th) group - 16 cases - we had used homograft conduit from RV to PA. VI(th) group - reconstructions were made through right atrium incision - 6 cases. RESULTS Early postoperative mortality 13.2% In I(st) group 10 (12%) patients died, in II(nd) group 3 (11.1%), in III(rd) - 14 (14.4%), in IV(th) - 4 (13.3%) and in V(th) - 3 (18.7%). In group VI nobody died. Main reason of death was acute heart insufficiency because of too high residual RV pressure. CONCLUSIONS Radical correction of TF may be safely performed for patients of all ages. Early postoperative mortality doesn't depend on way of correction. Main reason of early postoperative deaths is heart insufficiency because of too high residual RV pressure.
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Affiliation(s)
- Rimantas Karalius
- Heart Surgery Center Vilnius University, Santariskiu 2, 2021 Vilnius, Lithuania
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Newburger JW, Jonas RA, Soul J, Kussman BD, Bellinger DC, Laussen PC, Robertson R, Mayer JE, del Nido PJ, Bacha EA, Forbess JM, Pigula F, Roth SJ, Visconti KJ, du Plessis AJ, Farrell DM, McGrath E, Rappaport LA, Wypij D. Randomized trial of hematocrit 25% versus 35% during hypothermic cardiopulmonary bypass in infant heart surgery. J Thorac Cardiovasc Surg 2008; 135:347-54, 354.e1-4. [PMID: 18242267 DOI: 10.1016/j.jtcvs.2007.01.051] [Citation(s) in RCA: 93] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2006] [Revised: 01/09/2007] [Accepted: 01/29/2007] [Indexed: 11/17/2022]
Abstract
OBJECTIVES We previously reported that postoperative hemodynamics and developmental outcomes were better among infants randomized to a higher hematocrit value during hypothermic cardiopulmonary bypass. However, worse outcomes were concentrated in patients with hematocrit values of 20% or below, and the benefits of hematocrit values higher than 25% were uncertain. METHODS We compared perioperative hemodynamics and, at 1 year, developmental outcome and brain magnetic resonance imaging in a single-center, randomized trial of hemodilution to a hematocrit value of 25% versus 35% during hypothermic radiopulmonary bypass for reparative heart surgery in infants undergoing 2-ventricle repairs without aortic arch obstruction. RESULTS Among 124 subjects, 56 were assigned to the lower-hematocrit strategy (24.8% +/- 3.1%, mean +/- SD) and 68 to the higher-hematocrit strategy (32.6% +/- 3.5%). Infants randomized to the 25% strategy, compared with the 35% strategy, had a more positive intraoperative fluid balance (P = .007) and lower regional cerebral oxygen saturation at 10 minutes after cooling (P = .04) and onset of low flow (P = .03). Infants with dextro-transposition of the great arteries in the 25% group had significantly longer hospital stay. Other postoperative outcomes, blood product usage, and adverse events were similar in the treatment groups. At age 1 year (n = 106), the treatment groups had similar scores on the Psychomotor and Mental Development Indexes of the Bayley Scales; both groups scored significantly worse than population norms. CONCLUSIONS Hemodilution to hematocrit levels of 35% compared with those of 25% had no major benefits or risks overall among infants undergoing 2-ventricle repair. Developmental outcomes at age 1 year in both randomized groups were below those in the normative population.
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Affiliation(s)
- Jane W Newburger
- Department of Cardiology, Children's Hospital Boston, Boston, Mass 02115, USA.
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Monteiro AJO, Canale LS, Rangel I, Wetzel E, Pinto DF, Barbosa RC, Méier MA, Marcial MLB. Surgical treatment of complete atrioventricular septal defect with the two-patch technique: early-to-mid follow-up. Interact Cardiovasc Thorac Surg 2007; 6:737-40. [PMID: 17766275 DOI: 10.1510/icvts.2007.161778] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
We report our results on surgical treatment of complete atrioventricular septal defects using the two-patch technique. Forty patients with complete atrioventricular septal defects were operated on in the period from November 1995 to January 2004 and retrospectively analyzed. The age at the time of surgery ranged from 4 months to 20 years (average=18.8+/-37 months). Their weights ranged from 3 to 39 kg (average=7.6+/-5.8 kg). Associated tetralogy of Fallot was present in 20% of the cases (8 patients). Monitoring was complete until January 2007, corresponding to a follow-up ranging from 36 to 135 months (average=74+/-33.7 months). The surgical mortality rate was 2.5% and the hospital mortality rate was 5%. A third patient died from a brain abscess two years after surgery. Over the long-term, two patients needed further operations: one was submitted to mitral plasty due to severe residual mitral insufficiency, one year later; the other underwent a resection of a sub-aortic membrane after three years. Differences were evaluated using the Student-t or Mann-Whitney tests. Surgical treatment of complete atrioventricular septal defect using the two-patch technique results in low morbidity and mortality in early-to-mid term follow-up.
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Affiliation(s)
- Andrey J O Monteiro
- Cardiac Surgery Department, Pro-Cardíaco Hospital, General Polidoro Street 192, Botafogo, Rio de Janeiro, RJ, 22280-000 Brazil.
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Seddio F, Migliazza L, Borghi A, Crupi G. Previous palliation in patients with tetralogy of Fallot does not influence the outcome of later repair. J Cardiovasc Med (Hagerstown) 2007; 8:119-22. [PMID: 17299294 DOI: 10.2459/01.jcm.0000260214.27450.c9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE Primary repair is the treatment of choice in patients with tetralogy of Fallot. The timing of repair, however, remains controversial, and an initial palliative procedure might be considered a valuable option in the early management of symptomatic young infants and in those with either unfavourable anatomy, major associated lesions or chromosomal abnormalities with a poor life expectancy. METHODS We reviewed the management of 100 consecutive patients with tetralogy of Fallot who were operated upon at our department during an 8-year period from June 1995 to March 2003. The rationale for the choice of the initial management and the outcome in terms of morbidity and mortality in patients who underwent primary repair was compared to that observed in patients who had had a two-stage repair. RESULTS Age less than 3 months, the presence of either an unfavourable anatomy or major associated defects and genetic disorders with poor life expectancy were the indications for an initial palliation, which was carried out in 31 patients. There were no hospital deaths, and 28 of these patients underwent later repair with one hospital death (3.5%). Two patients with severe chromosomal abnormalities died at home and the remainder required a further palliation because of severely hypoplastic pulmonary arteries. Primary repair was carried out in 69 patients with one hospital death (1.4%). A transannular patch, which was used in 80% of our patients, was not an incremental risk factor for death regardless of the type of repair. Eight patients were reoperated on because of either residual right ventricular outflow tract obstruction with (four patients) or without (one patient) residual ventricular septal defect or isolated residual ventricular septal defect (three patients). All reoperations occurred in patients undergoing primary repair. CONCLUSIONS The outcome of patients undergoing repair of tetralogy of Fallot is not influenced in terms of either mortality or morbidity by an initial palliative procedure.
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Affiliation(s)
- Francesco Seddio
- Centre for the Diagnosis and Treatment of Congenital Heart Defects, Ospedali Riuniti di Bergamo, Bergamo, Italy
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Anagnostopoulos P, Azakie A, Natarajan S, Alphonso N, Brook MM, Karl TR. Pulmonary valve cusp augmentation with autologous pericardium may improve early outcome for tetralogy of Fallot. J Thorac Cardiovasc Surg 2007; 133:640-7. [PMID: 17320558 DOI: 10.1016/j.jtcvs.2006.10.039] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2006] [Revised: 09/23/2006] [Accepted: 10/09/2006] [Indexed: 11/23/2022]
Abstract
OBJECTIVES The transannular patch used to relieve right ventricular outflow tract obstruction in children with tetralogy of Fallot may result in pulmonary insufficiency. We hypothesized that pulmonary valve cusp augmentation with pericardium would decrease pulmonary insufficiency and improve the early outcome for transatrial-transpulmonary tetralogy of Fallot repair requiring transannular patch. METHODS Since November 2001, 41 patients with tetralogy of Fallot and 2 patients with isolated pulmonary valve stenosis had relief of right ventricular outflow tract obstruction with either a transannular patch plus pulmonary valve cusp augmentation (n = 18) or a transannular patch alone (n = 25). Data were retrospectively collected. RESULTS The median age (5.3 vs 3.2 months; P = .09) and weight (6.4 vs 5.2 kg; P = .3) were similar for the cusp augmentation and transannular patch groups, respectively. The diameter of the pulmonary valve annulus (6.4 vs 6.0 mm; P = .57) and the McGoon index (1.47 vs 1.69, P = .75) were also similar. The mean aortic clamp time (48 +/- 18 minutes vs 52 +/- 19 minutes; P = .46) and median cardiopulmonary bypass time (89 vs 91 minutes; P = .9) did not differ. One patient with a transannular patch died of multiorgan system failure. Patients with a pulmonary valve cusp augmentation had a shorter duration of intubation (1 vs 3 days; P < .001) and intensive care unit stay (2 vs 8 days; P < .001). Thirteen patients with a transannular patch and 1 patient with a pulmonary valve cusp augmentation required inotropic support for more than 72 hours (P = .001). Discharge echocardiograms demonstrated moderate or severe pulmonary insufficiency in 5 patients with a pulmonary valve cusp augmentation and in 21 patients with a transannular patch (P < .001). At 7.5 months, 3 patients (17%) with a pulmonary valve cusp augmentation had progression of pulmonary insufficiency. CONCLUSIONS Augmentation of a pulmonary valve cusp reduces the incidence of clinically significant postoperative pulmonary insufficiency. This technique may improve the early outcome for children with tetralogy of Fallot requiring a transannular patch.
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Affiliation(s)
- Petros Anagnostopoulos
- Division of Pediatric Cardiac Surgery, Pediatric Heart Center, University of California at San Francisco Children's Hospital, San Francisco, Calif, USA
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Alsoufi B, Williams WG, Hua Z, Cai S, Karamlou T, Chan CC, Coles JG, Van Arsdell GS, Caldarone CA. Surgical outcomes in the treatment of patients with tetralogy of Fallot and absent pulmonary valve. Eur J Cardiothorac Surg 2007; 31:354-9; discussion 359. [PMID: 17215132 DOI: 10.1016/j.ejcts.2006.12.001] [Citation(s) in RCA: 37] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2006] [Revised: 11/14/2006] [Accepted: 12/04/2006] [Indexed: 10/23/2022] Open
Abstract
OBJECTIVE Tetralogy of Fallot and absent pulmonary valve (TOF/APV) is associated with significant pulmonary artery dilatation and airway compression. Treatment of infants presenting with respiratory symptoms early in life is associated with high mortality (20-60%). We aim to report our results and identify factors associated with survival and prolonged ventilation. METHODS We performed a retrospective review of 62 consecutive patients following repair of TOF/APV (1982-2006). Median age at repair was 1.4 years (1 day-35 years). Twenty patients required preoperative intubation. RESULTS Sixty-one patients underwent complete repair. Thirty-three patients underwent pulmonary artery plication (n=15) or reduction (n=18). The right ventricular outflow tract (RVOT) was reconstructed with valved conduit (n=31), bioprosthetic valve (n=18), monocusp (n=8), or transannular patch (n=4). There were three perioperative and five late deaths. All perioperative deaths were in neonates and before 1995. Five- and ten-year survival was 93+/-4% and 87+/-5%. Mean ventilatory requirements for neonates, infants, and children > or =1 year were 36+/-35, 8+/-8, and 2.6+/-2.4 days (p<0.0001). On multivariable analysis, significant factors associated with prolonged ventilation were neonates (p<0.0001) and preoperative mechanical ventilation (p=0.088). Eight airway reinterventions were needed in seven infants with persistent postoperative airway compromise, pulmonary artery suspension (n=4), innominate artery suspension (n=2), and lobectomy (n=2). Freedom from RVOT reoperation was 89+/-5% and 59+/-9% at 5 and 10 years. There were no significant risk factors for time-related survival or RVOT reoperation on multivariable analysis. CONCLUSIONS In contrast to children and adults with TOF/APV, neonates and small infants presenting with respiratory symptoms require prolonged ventilation and additional reinterventions for airway compression. Our current surgical approach which includes reduction and suspension of pulmonary arteries, reconstruction of a competent RVOT, and aggressive postoperative ventilatory management to relieve airway obstruction offers satisfactory outcomes.
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Affiliation(s)
- Bahaaldin Alsoufi
- The Cardiac Centre, Hospital for Sick Children and the University of Toronto, Toronto, Ontario, Canada.
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Liu XG, Wu KH, Li XF, Shi C, Wang ZY, Tang Z, Shi XQ, Liu YL. Simultaneous Enlargement of the Pulmonary Annulus and the Pulmonary Cusp with Autologous Pericardium in Right Ventricular Outflow Tract Reconstruction. J Surg Res 2006; 136:320-4. [PMID: 17059834 DOI: 10.1016/j.jss.2006.08.024] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2006] [Revised: 08/18/2006] [Accepted: 08/25/2006] [Indexed: 10/24/2022]
Abstract
BACKGROUND Surgical repair of obstructive lesions of the right ventricular outflow tract (RVOT) commonly creates pulmonary valve incompetence, which continues to stimulate research for the optimal materials and surgical techniques to reconstruct RVOT. In this study, we present the early results with simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium in RVOT reconstruction. PATIENTS AND METHODS From January 2003 to December 2005, the surgical technique of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp was used in 32 patients who had complex congenital heart anomalies with pulmonary artery hypoplasia. The functional status of the patients was followed up in the cardiologic clinic of our institute. The motion of the newly constructed valve and the degree of pulmonary insufficiency were evaluated by echocardiography before discharge and at 2-6 months, 12 months, and 36 months postoperatively. RESULTS Early death occurred in one patient (3.1%). Postoperative complications occurred in six patients but they recovered uneventfully. During the follow-up, 28 of 31 operative survivors were in New York Heart Association functional class I without medication and the other three were in class II. Seventeen patients had no or trivial pulmonary regurgitation; mild regurgitation was present in 12 patients, and moderate regurgitation was seen in 2 patients. None of these patients needed reoperation and echocardiography showed good motion of the reconstructed valve. CONCLUSIONS The surgical technique of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium is a safe, reliable, and effective way for RVOT reconstruction. Satisfactory early results have been achieved; however, long-term follow-up is necessary to determine the true value of this technique.
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Affiliation(s)
- Xue Gang Liu
- Department of Cardiothoracic Surgery, Affiliated Hospital of Bengbu Medical College, Bengbu, China
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Karamlou T, McCrindle BW, Williams WG. Surgery Insight: late complications following repair of tetralogy of Fallot and related surgical strategies for management. ACTA ACUST UNITED AC 2006; 3:611-22. [PMID: 17063166 DOI: 10.1038/ncpcardio0682] [Citation(s) in RCA: 54] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2005] [Accepted: 06/19/2006] [Indexed: 11/09/2022]
Abstract
Biventricular correction of tetralogy of Fallot was devised more than 50 years ago. Current short-term outcomes are excellent. The potential for late complications is, however, an important concern for the growing number of postrepair survivors. Progressive pulmonary valve regurgitation leading to right heart failure and arrhythmia are centrally important problems faced by these patients. New techniques are, however, likely to change the future outcomes for postrepair survivors. These techniques include percutaneous valve replacement, arrhythmia ablation surgery, and strategies that emphasize preservation of the pulmonary valve even at the cost of leaving some residual valvular stenosis. The objectives of this Review are to outline the major complications that arise late after repair of tetralogy of Fallot, to describe the surgical approaches that have been developed to avoid and manage arising complications, and to briefly explore how novel treatment paradigms could change the future long-term outlook for patients following tetralogy repair.
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Affiliation(s)
- Tara Karamlou
- Division of Cardiovascular Surgery, The Hospital for Sick Children, 555 University Avenue, Toronto, ON M5G 1X8, Canada
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Abstract
BACKGROUND The long-term results of patients with tetralogy of Fallot surgically treated in adulthood were evaluated to define the real benefit of surgical correction. METHODS Between August 1990 and February 2004, 57 patients older than 18 years of age with tetralogy of Fallot received total correction. Forty-two patients (73.7 %) required transannular patch. RESULTS Hospital and late mortality were 7.0 % (n = 4) and 5.7 % (n = 3), respectively. One patient was reoperated on to close residual ventricular septal defect. Four patients were lost. Of the remaining 49 patients, the mean follow-up was 65 +/- 38 months (range 11 - 173 months). Actuarial survival was 97.4 +/- 2.5 %, 91 +/- 7 % and 72.8 +/- 17.1 % at 5, 10 and 14 years, respectively. At the latest follow-up, 35 (76.1 %) of the surviving patients presently have NYHA functional class I ( P < 0.01). CONCLUSION The overall survival of surgically treated adult patients with tetralogy of Fallot is acceptable. The greatest benefit of total correction at this age is the functional improvement.
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Affiliation(s)
- X Lu
- Department of Cardiovascular Surgery, Qilu Hospital, Shandong University, WenHuaXi Road 10, Jinan 250012, China
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Mohammadi S, Belli E, Martinovic I, Houyel L, Capderou A, Petit J, Planché C, Serraf A. Surgery for right ventricle to pulmonary artery conduit obstruction: risk factors for further reoperation☆. Eur J Cardiothorac Surg 2005; 28:217-22. [PMID: 15967672 DOI: 10.1016/j.ejcts.2005.04.014] [Citation(s) in RCA: 54] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2005] [Revised: 03/22/2005] [Accepted: 04/25/2005] [Indexed: 11/16/2022] Open
Abstract
OBJECTIVE To identify the surgical approaches and risk factors which influence longevity of right ventricle to pulmonary artery (RV-PA) conduits following first reoperation for obstruction. METHODS Between January 1993 and August 2003, 114 patients underwent 141 reoperations for RV-PA conduit obstruction. Diagnoses included 'Truncus Arteriosus' (n=52), 'Pulmonary atresia/Tetralogy of fallot' (n=39), 'Double outlet right ventricle' (n=10), 'Transposition of great arteries, VSD, and pulmonary atresia' (n=9), and the 'Ross operation' (n=4). All patients had undergone a previous biventricular repair. The first reoperation for conduit obstruction was performed in 112 hospital survivors by: total conduit replacement (Group A, n=73) with valved (homograft=10 and xenograft=54) or non-valved (n=9) conduit, and patch enlargement of the obstructed RV outflow tract with preservation of the posterior and sides of the conduit wall after removing of the fibrocalcific peel and degenerated valve (Group B, n=39). Mean age at first reoperation was 8.8+/-6.7 and 7.5+/-5.3 years in patients of groups A and B, respectively. Seven patients in Group A and 18 in Group B required a second reoperation and two patients in Group B a third reoperation. RESULTS There were two hospital deaths and no late deaths. Mean follow-up was 5.8+/-3.2 years. Risk factors for second reoperation by univariate analysis were: homograft conduit use (P=0.004), Group B surgical approach (P=0.0001), higher RV-PA systolic pressure gradient at discharge (P=0.02), and age <5-years-old (P=0.01). Multivariate analysis showed that inclusion in Group B and younger age (<5-years-old) at repair were independent risk factors for second reoperation. Group B surgical approaches had higher RV-PA systolic pressure gradient at discharge (P=0.02) and required more PA bifurcation repair at the time of second reoperation (P=0.05). Freedom from second reoperation for conduit obstruction was significantly higher in Group A patients at 5 and 8 years (P<0.04) and those with xenografts rather than homograft (P=0.04). CONCLUSIONS Our results support the optimal surgical approach for RV-PA conduit obstruction is total replacement with a xenograft. RV outflow reconstruction by other techniques without complete dissection of PA bifurcation does not completely relieve the stenosis and could cause early restenosis. Higher systolic gradients at discharge and younger age at first reoperation are predictors of earlier reoperation.
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Affiliation(s)
- Siamak Mohammadi
- Department of Pediatric Cardiac Surgery, Marie-Lannelongue Hospital, 133 Ave de la Résistance, 92350 Le Plessis-Robinson, France
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Amorim S, Cruz C, Macedo F, Bastos PT, Gonçalves FR. Tetralogy of Fallot: prognostic factors after surgical repair. Rev Port Cardiol 2005; 24:845-55. [PMID: 16121676] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
INTRODUCTION AND OBJECTIVE Corrective surgery for tetralogy of Fallot (TF) has led to excellent survival. However; several years after surgery, the majority of patients have right ventricular (RV) dilatation, and 10% will need reoperation of the RV outflow tract due to limited exercise capacity, ventricular arrhythmias or symptoms of heart failure (HF). Our aim was to identify predictive factors of adverse outcome: moderate to severe RV dilatation, HF, reoperation of the RV outflow tract and cardiac death. METHODS Eighty-eight adult patients with TF were operated between January 1977 and July 2001; 22 were lost to follow-up and 66 were followed for 18 +/- 6 years. We analyzed clinical, electrocardiographic and echocardiographic variables. RV dilatation was considered to exist if the inlet measurement at end-diastole in 4-chamber apical view was more than 35 mm, being classified as moderate when > or = 50 and < 60 mm and severe when > or = 60 mm. RESULTS Of the 66 patients, 25 (37.9%) had undergone previous palliative shunt (PS) at the age of 4 +/- 5 years. Mean age at surgical correction was 10 +/- 8 years (range: < 1 to 38 years; median: 6.5 years). Transannular patching was used in 65% of patients, patch closure of a right ventriculotomy in 91%, and in 53% of patients a pulmonary commissurotomy was performed. At the end of follow-up, 3 patients were in NYHA class III-IV and one patient was successfully reoperated with implantation of a biological pulmonary valve. Prevalence of RV dilatation was 97% (57/59), being moderate to severe in 69% (36/52). In patients with moderate to severe RV dilatation we found previous PS (18.8 vs. 50.0%; p = 0.03), transannular patching (37.5 vs. 75.0%; p 0.01) and wide QRS (160 ms) (6.7 vs. 45.7%, p = 0.01) to be more frequent. These patients reported more palpitations (0 vs. 22.2%; p 0.05), but there were no differences in arrhythmic events (18.8 vs. 33.3%; p = 0.28); maximal heart rate on exercise was lower (86.2 +/- 10.9 vs. 79.9 +/- 8.6; p = 0.04), but exercise time and functional capacity were similar between the groups. Follow-up time and use of RV patching were similar. Transannular patching was associated with previous PS at an older age (0.9 +/- 0.7 vs. 4.9 +/- 5.7 years; p = 0.01), a higher grade of pulmonary regurgitation (III-IV) (22.7 vs. 57.5%; p = 0.01), wide QRS (160 ms) (9.5 vs. 41.0%, p = 0.01), and greater RV dilatation. No mortality was reported. CONCLUSION Transannular patching and performance of previous PS were predictive factors of severe RV dilatation, and pulmonary regurgitation seems to be its physiological mechanism. Despite this, long-term prognosis is favorable and patients have good functional capacity.
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Affiliation(s)
- Sandra Amorim
- Serviço de Cardiologia, Hospital de São João, Porto, Portugal.
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Erdoğan HB, Bozbuğa N, Kayalar N, Erentuğ V, Omeroğlu SN, Kirali K, Ipek G, Akinci E, Yakut C. Long-Term Outcome After Total Correction of Tetralogy of Fallot in Adolescent and Adult Age. J Card Surg 2005; 20:119-23. [PMID: 15725134 DOI: 10.1111/j.0886-0440.2005.200374df.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Although most patients with tetralogy of Fallot (TOF) undergo radical repair during infancy and childhood, patients remaining undiagnosed and untreated until adulthood can still be treated. These patients have either a previous palliative or natural collateral circulation to the lung or a mild form of right ventricular outflow tract (RVOT) obstruction. The aim of this study is to analyze the perioperative and long-term results of radical corrective procedures in patients who reached adult ages. Two hundred and seven patients with TOF underwent complete correction between 1985-and 2002, 64 (30.9%) of whom were aged 14 years or more. The mean age at corrective repair for this group was 20.6 +/- 7.5 years (range 14 to 49 years). Only two patients had previous modified Blalock-Taussig shunts. In 44 patients (68.7%) besides infundibular resection, a transannular gluteraldehyde-treated pericardial patch was used to reconstruct right ventricular outflow tract (RVOT). Only infundibular patching was used in 15 patients (23.4%) and infundibular muscular resection with primary closure of right ventricle was performed in five patients (7.8%). Hospital mortality was 3.1% with two patients. Four patients (6.2%) underwent reoperation because of recurrent ventricular septal defect (VSD) with/without residual obstruction or pulmonary regurgitation. All survivors were in NYHA class I (42) or II (17). Late mortality was recorded in two patients and 16-year actuarial survival was 89.2%+/- 4.9%. The significant negative predictors of late survival determined by univariate analysis were reoperation <0.018) and associated cardiac anomalies <0.011). Multivariate analysis showed that there was no negative predictor of late-term mortality. Corrective procedures in adult patients with TOF can be performed successfully compared to patients who underwent operation during infancy and childhood.
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Affiliation(s)
- Hasan Basri Erdoğan
- Department of Cardiovascular Surgery, Koşuyolu Heart and Research Hospital, Istanbul, Turkey.
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Abstract
After repair of tetralogy of Fallot, many patients present in need of reoperative surgical reconstruction of the right ventricular outflow tract. The predominant physiologic lesion is pulmonary insufficiency, but there may also be varying degrees of obstruction of the right ventricular outflow tract. In the past, it has been felt that patients tolerate pulmonary insufficiency reasonably well. In some patients, however, the long-term effects of pulmonary insufficiency and subsequent right ventricular dilation and dysfunction are associated with poor exercise tolerance and increased incidence of arrhythmias and sudden death.1,2 Numerous studies support replacement of the pulmonary valve as treatment for pulmonary insufficiency in order to improve performance, optimize hemodynamics, and better control arrhythmias.3–10 The indications for reconstruction of the right ventricular outflow tract in this setting, nonetheless, as well as the operative strategy, continue to evolve. There are multiple surgical options for replacement of the pulmonary valve for these patients, including aortic and pulmonary homografts, stented and stentless porcine valves, porcine valved conduits, bovine jugular venous conduits, and even mechanical valves and mechanical valved conduits.11–32 It was a less than ideal experience with these currently available options that stimulated our interest into employing alternative materials and techniques. Favorable experimental and clinical experience with valves made of a polytetrafluoroethylene monoleaflet33–36 encouraged us to consider a new method of reconstruction with this material, using a bifoliate polytetrafluoroethylene valve. In this work, we review our indications for replacement of the pulmonary valve after repair of tetralogy of Fallot, the surgical options available, and our experience reconstructing the right ventricular outflow tract with a new surgically created bifoliate polytetrafluoroethylene valve.
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Affiliation(s)
- James A Quintessenza
- Congenital Heart Institute of Florida, All Children's Hospital, University of South Florida, Saint Petersburg, Florida 33701, United States of America.
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Abstract
The first repair of tetralogy of Fallot (TOF) was 50 years ago, so it would seem that the details for optimal management strategies would be clear. Timing of repair and operative repair strategy for TOF are still a source of debate. Varying institutions have published excellent outcomes with a primary repair strategy or a selective staged repair strategy. In this article, the current and historic strategy for repair of TOF at the Hospital for Sick Children in Toronto is delineated along with associated outcomes. Data from our institution indicate a clear survival advantage for primary repair of TOF.
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Veldtman GR, Connolly HM, Grogan M, Ammash NM, Warnes CA. Outcomes of pregnancy in women with tetralogy of fallot. J Am Coll Cardiol 2004; 44:174-80. [PMID: 15234429 DOI: 10.1016/j.jacc.2003.11.067] [Citation(s) in RCA: 126] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/19/2003] [Revised: 10/24/2003] [Accepted: 11/24/2003] [Indexed: 11/18/2022]
Abstract
OBJECTIVES We sought to determine pregnancy outcomes in patients with tetralogy of Fallot (TOF). BACKGROUND Pregnancy outcomes in patients with TOF are incompletely defined. METHODS Clinical, hemodynamic, and obstetric data were reviewed for women with TOF and prior pregnancy. RESULTS Of 72 respondents, 43 (mean age, 26 years) had 112 pregnancies (range, 1 to 5); 82 pregnancies were successful. Eight women had unrepaired TOF at the time of their 20 successful pregnancies. At first assessment (age > or =18 years), six patients had pulmonary hypertension, three had moderate or severe right ventricular (RV) systolic dysfunction, and 13 had severe RV dilation due to pulmonic regurgitation. Sixteen patients had 30 miscarriages (27%) and one term stillbirth. Mean overall birth weight was 3.2 kg (range, 2.1 to 4.2 kg). Unrepaired TOF (p = 0.05) and morphologic pulmonary artery abnormality (p = 0.03) were independently predictive of infant birth weight. Six patients had cardiovascular complications during pregnancy: supraventricular tachycardia in two, heart failure in two, pulmonary embolism in a patient with pulmonary hypertension, and progressive RV dilation in a patient with severe pulmonic regurgitation. Five infants (6%) had congenital anomalies. CONCLUSIONS Patients with TOF have an increased risk of fetal loss, and their offspring are more likely to have congenital anomalies than offspring in the general population. Adverse maternal events, although rare, may be associated with left ventricular dysfunction, severe pulmonary hypertension, and severe pulmonic regurgitation with RV dysfunction.
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MESH Headings
- Adult
- Aorta, Thoracic/pathology
- Aorta, Thoracic/surgery
- Cardiac Surgical Procedures
- Coronary Vessel Anomalies/diagnosis
- Coronary Vessel Anomalies/surgery
- Female
- Follow-Up Studies
- Heart Septal Defects, Ventricular/physiopathology
- Heart Septal Defects, Ventricular/surgery
- Humans
- Maternal Welfare
- Minnesota
- Pregnancy
- Pregnancy Complications, Cardiovascular/diagnosis
- Pregnancy Complications, Cardiovascular/etiology
- Pregnancy Complications, Cardiovascular/mortality
- Pregnancy Complications, Cardiovascular/surgery
- Pregnancy Outcome
- Pulmonary Artery/pathology
- Pulmonary Artery/surgery
- Stroke Volume/physiology
- Survival Analysis
- Tetralogy of Fallot/diagnosis
- Tetralogy of Fallot/mortality
- Tetralogy of Fallot/surgery
- Treatment Outcome
- Ventricular Dysfunction, Left/physiopathology
- Ventricular Dysfunction, Left/surgery
- Ventricular Outflow Obstruction/physiopathology
- Ventricular Outflow Obstruction/surgery
- Ventricular Pressure/physiology
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Affiliation(s)
- Gruschen R Veldtman
- Division of Cardiovascular Diseases and Internal Medicine, Mayo Clinic, Rochester, Minnesota 55905, USA
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Carotti A, Marino B, Di Donato RM. Influence of chromosome 22q11.2 microdeletion on surgical outcome after treatment of tetralogy of fallot with pulmonary atresia. J Thorac Cardiovasc Surg 2004; 126:1666-7. [PMID: 14666061 DOI: 10.1016/s0022-5223(03)01196-6] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Nakazawa M, Shinohara T, Sasaki A, Echigo S, Kado H, Niwa K, Oyama K, Yokota M, Iwamoto M, Fukushima N, Nagashima M, Nakamura Y. Arrhythmias Late After Repair of Tetralogy of Fallot-A Japanese Multicenter Study-. Circ J 2004; 68:126-30. [PMID: 14745146 DOI: 10.1253/circj.68.126] [Citation(s) in RCA: 43] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND Arrhythmia is a major late complication in adults with repaired tetralogy of Fallot, although a large-scale study has not been carried out in Japan. METHODS AND RESULTS A nationwide multicenter study with 512 operative survivors was performed. Actuarial survival rate at 30 years (maximum follow-up) was 98.4%. Fifty-four patients (10.5%) had clinically important arrhythmias, including 23 patients with bradycardia caused by sick sinus syndrome or atrioventricular block (AVB). A patient with complete AVB (CAVB) without pacemaker implantation (PMI) died later. Two patients had sustained ventricular tachycardia (VT) and syncope was reported in 18 patients with ventricular arrhythmias (VA). Atrial tachyarrhythmias were observed in 13 patients. Older age at operation was a risk factor for atrial fibrillation/flutter, longer postoperative survival duration for VA, and QRS duration >120 ms for VT. Perimembranous ventricular septal defect was related to CAVB. Right ventricular outflow patch was not a risk factor. Importantly, 60% of the subjects had QRS duration <120 ms. CONCLUSION The prevalence of serious arrhythmias is low in Japanese TOF patients as compared with the results from Western countries. CAVB without PMI and VT are the major risk factors for late morbidity and mortality. The excellent result could be related to the narrow QRS after surgery.
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Affiliation(s)
- Makoto Nakazawa
- The Heart Institute of Japan, Tokyo Women's Medical University, Japan.
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Abstract
BACKGROUND Sudden cardiac death remains the most common cause of death after repair of tetralogy of Fallot. It has been suggested that sudden cardiac death is related to right ventricular hypertrophy or dilation. However, it is uncertain whether the preoperative patient status or operative techniques predispose for sudden cardiac death. METHODS From 1958 to 1977, 658 patients underwent repair of tetralogy of Fallot at our institution at a median age of 12.2 +/- 8.6 years. One third had at least one previous palliative operation 4.6 +/- 2.5 years earlier. A total of 490 patients survived the first postoperative year and were analyzed for sudden cardiac death. During a follow-up period of 25.3 +/- 5.8 years (range, 1.0 to 35.5 years), 42 patients died, and 15 (36%) of those deaths were as a result of sudden cardiac death. RESULTS Actuarial 10-year, 20-year, and 30-year survival rates were 97%, 94%, and 89%. Freedom from sudden cardiac death was 99%, 98%, and 95% after 10, 20, and 30 years. The risk of sudden cardiac death increased after 10 years from 0.06%/y to 0.20%/y. Univariate predictors (p < 0.1) of sudden cardiac death were use of an outflow tract patch (p = 0.068), male sex (p = 0.048), no previous palliation (p = 0.013), and higher preoperative New York Heart Association status (p = 0.014). Multivariate analysis confirmed these risk factors except use of an outflow tract patch. CONCLUSIONS The most important risk factors for sudden cardiac death were higher preoperative New York Heart Association class and no previous palliation. Thus, early surgical intervention is recommended. The risk of sudden cardiac death increases with time, suggesting that long-term follow-up by specialized cardiologists or pediatricians should be intensified. However, all patients who died suddenly had at least two risk factors at the time of surgery.
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Affiliation(s)
- Georg D A Nollert
- Clinic of Cardiac Surgery, Klinikum Grosshadern, University of Munich, Munich, Germany.
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Marshall AC, Love BA, Lang P, Jonas RA, del Nido PJ, Mayer JE, Lock JE. Staged repair of tetralogy of Fallot and diminutive pulmonary arteries with a fenestrated ventricular septal defect patch. J Thorac Cardiovasc Surg 2003; 126:1427-33. [PMID: 14666015 DOI: 10.1016/s0022-5223(03)01182-6] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
OBJECTIVES Patients with tetralogy of Fallot and diminutive pulmonary arteries are at risk for suprasystemic right ventricular pressure and right ventricular failure after complete repair. We report the short-term outcome and medium-term follow-up after using a fenestrated ventricular septal defect patch as a component of staged repair in selected patients. METHODS We reviewed 47 patients with tetralogy of Fallot and diminutive pulmonary arteries whose ventricular septal defect patch was fenestrated, either electively or as a rescue technique, at a single institution between 1984 and 2001. RESULTS Early mortality was 10.6% and occurred only in patients who underwent rescue fenestration. Review of medium-term follow-up (median, 39 months) revealed 4 late deaths; an additional 4 patients experienced right ventricular failure despite fenestration. Most (7/8) of these late events occurred in patients who underwent planned fenestration. Excessive left-to-right shunt through the fenestration developed in only 2 patients. CONCLUSIONS Fenestrated patch closure of the ventricular septal defect in patients with tetralogy of Fallot and diminutive pulmonary arteries resulted in 10.6% early mortality. Used preemptively in selected patients, this technique is associated with no surgical mortality and a low incidence of excessive left-to-right shunt (4%). Early survivors remain at risk for late death and right ventricular failure despite fenestration.
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Affiliation(s)
- Audrey C Marshall
- Department of Cardiology, Children's Hospital, Boston, MA 02115, USA.
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Ashburn DA, Harris L, Downar EH, Siu S, Webb GD, Williams WG. Electrophysiologic surgery in patients with congenital heart disease. Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2003; 6:51-8. [PMID: 12740771 DOI: 10.1053/pcsu.2003.50013] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
As patients with congenital heart disease increase in number and age, arrhythmia is becoming a more prevalent and important clinical problem. Although catheter-based therapy has revolutionized the management of arrhythmia, there remains an increasing patient population with congenital heart disease presenting for repair or reoperation with associated atrial or ventricular arrhythmias. Arrhythmia ablation may be safely and effectively included as an adjunct to repair of underlying structural cardiac lesions. Successful electrophysiologic surgery requires accurate preoperative characterization of the arrhythmia.
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MESH Headings
- Arrhythmias, Cardiac/complications
- Arrhythmias, Cardiac/mortality
- Arrhythmias, Cardiac/surgery
- Cardiac Surgical Procedures/methods
- Catheter Ablation/methods
- Child, Preschool
- Combined Modality Therapy
- Electrophysiology
- Female
- Follow-Up Studies
- Heart Defects, Congenital/complications
- Heart Defects, Congenital/mortality
- Heart Defects, Congenital/surgery
- Heart Septal Defects, Atrial/complications
- Heart Septal Defects, Atrial/mortality
- Heart Septal Defects, Atrial/surgery
- Humans
- Infant
- Infant, Newborn
- Male
- Risk Assessment
- Severity of Illness Index
- Survival Analysis
- Tachycardia, Supraventricular/complications
- Tachycardia, Supraventricular/mortality
- Tachycardia, Supraventricular/surgery
- Tetralogy of Fallot/complications
- Tetralogy of Fallot/mortality
- Tetralogy of Fallot/surgery
- Treatment Outcome
- Wolff-Parkinson-White Syndrome/complications
- Wolff-Parkinson-White Syndrome/mortality
- Wolff-Parkinson-White Syndrome/surgery
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Affiliation(s)
- David A Ashburn
- Toronto Congenital Cardiac Center for Adults, Toronto General Hospital, Ontario, Canada
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Prifti E, Crucean A, Bonacchi M, Bernabei M, Luisi VS, Murzi B, Vanini V. Total correction of complete atrioventricular septal defect with tetralogy of Fallot. J Heart Valve Dis 2003; 12:640-8. [PMID: 14565719] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 04/27/2023]
Abstract
BACKGROUND AND AIM OF THE STUDY The authors' experience in surgical management of tetralogy of Fallot in association with complete atrioventricular septal defect (CAVSD-TOF) is reported. METHODS Between January 1990 and September 2001, 146 children with CAVSD underwent complete correction. ASD closure was performed using a one-patch technique, with autologous pericardial patch. Seventeen patients presented with CAVSD-TOF, of whom nine (53%) had undergone previous palliation. Mean age at repair was 2.9 +/- 1.9 years. The mean gradient across the right ventricular outflow tract (RVOT) was 63 +/- 16 mmHg. Six patients (35%) required a transannular patch. RESULTS Overall in-hospital mortality was 10%. Among patients with CAVSD-TOF, three died in hospital (18%); causes of death were progressive heart failure (n = 2) and multiple organ failure (n = 1). Two patients required mediastinal exploration due to significant bleeding, and two late reoperation for severe left atrioventricular valve regurgitation after intracardiac repair. Mean follow up was 36 +/- 34 months. All patients survived and are currently in NYHA class I or II. At follow up, mean gradient across the RVOT was 17 +/- 6 mmHg, significantly less than the preoperative value (p < 0.001). CONCLUSION Complete repair in patients with CAVSD-TOF offers acceptable early and mid-term outcome in terms of mortality, morbidity and reoperation rate. Palliation prior to repair may be preferred in cases with small pulmonary arteries, or in severely cyanotic neonates. The RVOT should be managed as for isolated TOF, but a transatrial-transpulmonary approach is the surgery of choice.
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Affiliation(s)
- Edvin Prifti
- Division of Pediatric Cardiac Surgery, G. Pasquinucci Hospital, CREAS-IFC-CNR, Massa, Italy
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