Abstract
Background
The optimal management strategy for symptomatic young infants with tetralogy of Fallot
(TOF) is yet to be determined. We aimed to evaluate the long-term outcomes of a staged
approach with initial shunt palliation followed by complete repair.
Methods
Between January 1993 and July 2021, 160 children with TOF underwent a systemic-to-pulmonary
shunt at our institution, including 65 neonates (41%). The mean duration of follow-up
was 12.3 ± 8.1 years.
Results
Hospital mortality was 3% (4 of 160), all occurring in patients with a shunt size-to-weight
ratio ≥1.2 mm/kg. Composite morbidity—defined as cardiac arrest, postoperative mechanical
circulatory support, or unplanned reoperation—occurred in 21% (33 of 160). On multivariable
analysis, a shunt size-to-weight ratio ≥1.2 mm/kg and prematurity were independent
predictors of composite morbidity. Interstage mortality was 3% (4 of 156). A limited
transannular patch was used in 75% (113 of 150) of TOF repairs. Actuarial survival
at 20 years after shunt was 90% (95% confidence interval [CI], 79%-95%). Actuarial
freedom from reinterventions at 20 years after TOF repair was 40% (95% CI, 28%-52%).
Neonates had comparable composite morbidity, mortality, and late risk of reinterventions
to older children.
Conclusions
Staged repair of TOF in symptomatic young infants results in low mortality but high
rates of reinterventions at long-term follow-up. A shunt size-to-weight ratio ≥1.2 mm/kg
is a significant risk factor for mortality and morbidity prior to complete repair.
Neonates undergoing shunt insertion have comparable outcomes to older children.
Key Words
Abbreviations and Acronyms:
BTS (Blalock–Taussig shunt), CI (confidence interval), CPB (cardiopulmonary bypass), IQR (interquartile range), MBTS (modified Blalock–Taussig shunt), PA (pulmonary artery), PAPR (pulmonary annulus-preserving repair), PR (pulmonary regurgitation), PTFE (polytetrafluoroethylene), PVA (pulmonary valve annulus), RV (right ventricle), RVOT (right ventricular outflow tract), RVOTO (right ventricular outflow tract obstruction), TAP (transannular patch), TOF (tetralogy of Fallot)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: August 04, 2022
Accepted:
July 24,
2022
Received in revised form:
July 18,
2022
Received:
August 30,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery
