How Good Can Transventricular Repair In Newborns With Tetralogy Of Fallot Be?
Soichiro Hemmi, Aybala Tongut, Mahmut Ozturk, Kei Kobayashi, Satoshi Miyairi, Can Yerebakan, Yves d'Udekem.
Children's National Hospital, Washington, DC, USA.
Objective(s): The optimal strategy (staged repair with initial palliation vs primary full repair) of neonates and young infants with tetralogy of Fallot (TOF) has been debatable. We aimed to review our outcomes and determine risk factors contributing to postoperative reintervention in patients with TOF. Methods: We retrospectively reviewed consecutive 233 patients with TOF who underwent primary full repair at ≤120 days of age from 2004 to 2019. 204 patients (88%) received transventricular approach. 57 (24%) patients born in prematurity, 51 (22%) patients were low birth weight (<2.5kg), and 37 (16%) patients had genetic syndrome. Mean follow-up period was 6.7 ± 4.9 years. Results: Three (1.3%) in-hospital death were recorded. The 10-year overall survival rate was 97.0±1.4%. The 10-year freedom from all-cause re-intervention rate was 71.2±3.5%. Freedom from reintervention for RVOTO, RV dilatation or PA stenosis at 10-year by Kaplan Meier estimate were 82.4±3.1%, 97.9±1.2% or 88.4±2.4%. Multivariable Cox hazard analysis demonstrated that transannular patch (HR:0.06, 95%CI:0.01-0.24, p<.001), older age at TOF repair (HR:0.99, 95%CI:0.97-1.00, p=.03) and increasing PV annulus Z score (HR:0.61, 95%CI:0.36-0.99, p=.04) were associated with a reduced risk of reintervention for RVOTO and also transannular patch (HR:5.16, 95%CI:1.1-36.16, p=.04) was associated with a increased risk of reintervention for RV dilatation.
Conclusions: Our uniform policy of transventricular repair of newborns in TOF resulted in excellent long-term outcomes. Symptomatic patients, younger patients at repair and smaller PV annulus are at increased risk of needing transannular patch and exposed to higher risk of reintervention especially for RV dilatation.
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