Reoperation Risk After Tetralogy Of Fallot Repair Is Dependent On Patient Characteristics Rather Than Surgical Technique
Sara Hussain1, Charis Tan2, Ahmad Makhdoum3, Prisca Pondorfer4, Quazi Ibrahim5, Richard Whitlock1, Yves D’Udekem2, Glen Van Arsdell4.
1McMaster University, Hamilton, ON, Canada, 2Royal Children's Hospital, Victoria, Australia, 3University of Toronto, Toronto, ON, Canada, 4Hospital for Sick Children, Toronto, ON, Canada, 5Population Health Research Institute, Hamilton, ON, Canada.
Objectives: The majority of available studies are concerned with the impact of surgical repair timing and technique on late outcomes. We sought to determine the pre-operative patient-related predictors of cardiac re-operations.
Methods: A total of 402 TOF repair cases were performed at 2 institutions between 1996-2004. Charts were reviewed to obtain demographics, pre-operative RVOT gradients, operative details, and clinical outcomes. Kaplan-Meier curves and log-rank tests were used to compare re-operation occurrences between the repair strategies. A multi-variable cox regression model was used to determine the predictors of re-operations while adjusting for confounders.
Results: Median age at repair was 1.0(IQR 0.7) year. Cardiac re-operations were required for 47 patients (12%) and occurred at 6.8±5.3 years following repair. Indications for re-operation were RVOT stenosis in 26(55%) and RV dilation in 21(45%). Presence of pre-operative hyper-cyanotic spells was significantly associated with re-operations (HR 2.32, 95% CI 1.02-5.29, p=0.045). In addition, female gender was found to increase the hazard for reoperations (HR 2.07, 95% CI 1.06- 4.06, p=0.034). Re-operation occurrences did not vary between the repair strategies (p=0.14). Minimal trans-annular patching and annulus preservation strategies trended towards less hazard for re-operations in comparison to standard trans-annular patching.
Conclusions: Patients presenting with hyper-cyanotic spells may represent an innately high risk group for late complications independent of repair technique or timing. Modified follow-up with RV monitoring should be considered. A large multicentre cohort study is needed to provide further evidence to strengthen this hypothesis and its possible potential for practice change.
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