Tetralogy of fallot repair at a new centre in North India: our growing experience

Authors

  • Mayank Yadav Department of CTVS, Jawahar Lal Nehru Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India
  • Sumit Pratap Singh Department of CTVS, Jawahar Lal Nehru Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India
  • Mohd Azam Haseen Department of CTVS, Jawahar Lal Nehru Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India
  • Shaad Abqari Department of Pediatrics and PCE CS Unit, Jawahar Lal Nehru Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India
  • Mirza M. Kamran Department of Pediatrics and PCE CS Unit, Jawahar Lal Nehru Medical College and Hospital, AMU, Aligarh, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2349-2902.isj20205362

Keywords:

Complete surgical correction, New centre, Pediatric cardiac surgery, Tetralogy of fallot

Abstract

Background: Tetralogy of Fallot (TOF) is the most common cyanotic congenital heart disease with complete surgical repair being its most appropriate treatment currently. Although in a developing country, pediatric cardiac surgery is not being practiced as frequently as the adult cardiac surgery either due to limited resources centres or surgeon reluctance. The aim of this study is to evaluate and compare the operative and postoperative outcome of the initial 50 patients with the subsequent 50 patients undergoing corrective surgery of TOF in a new cardiac centre.

Methods: This is a comparative descriptive study performed at a single centre comprising of two groups of initial 50 and subsequent 50 patients who underwent complete surgical correction of TOF and compare their operative and postoperative outcomes.

Results: The mean age of patients in group I and II were 82.4 and 74.3 months respectively. There was no significant difference in the preoperative characteristics of the patients of both groups. Among operative parameters there was significant improvement in the cardiopulmonary bypass time and aortic cross clamp time in group 2 with p value of 0.0017 and 0.0324 respectively. The requirement for transannular patch also came down in group 2 (p=0.016). Mortality in group 1 and 2 were 6 and 2 respectively (p=0.14), other postoperative characteristics were similar in both groups.

Conclusions: With growing experience, proper planning and perseverance pediatric cardiac surgery too can be performed with acceptable results in a new centre.

References

Anderson RH, Weinberg PM. The clinical anatomy of tetralogy of Fallot. Cardiol Young. 2005;15(1):38-47.

Fallot A. Contribution to the pathological anatomy of blue disease (cardiac cyanosis). Marseille medical. 1963;100:779.

Castaneda AR, Freed MD, Williams RG, Norwood WI. Repair of tetralogy of Fallot in infancy. J Thorac Cardiovasc Surg. 1977;74:372–81.

Gustafson RA, Murray GF, Warden HE, Hill RC, Rozar GE. Early primary repair of tetralogy of Fallot. Ann Thorac Surg. 1988;45:235–41.

Steiner MB, Tang X, Gossett JM, Malik S, Prodhan P. Timing of complete repair of non-ductal dependent tetralogy of Fallot and short-term postoperative outcomes, a multicenter analysis. J Thorac Cardiovasc Surg. 2014;147:1299–305.

Van Arsdell GS, Maharaj GS, Tom J, Rao VK, Coles JG, Freedom RM et al. What is the optimal age for repair of tetralogy of Fallot? Circulation. 2000;32:89–92.

Matthews R, and Belsey R. Indications for the Brock operation in current treatment of tetralogy of Fallot. Thorax. 1973;28(1):1-8.

Borow KM, Green LH, Castaneda AR, Keane JF. Left ventricular function after repair of tetralogy of Fallot and its relationship to age at surgery. Circulation. 1980;61:1150–8.

Okoromah CAN, Ekure EN, Lesi FEA, Okunowo WO, Tijani BO, Okeiyi JC. Prevalence, profile and predictors of malnutrition in children with congenital heart defects: a case-control observational study. Arch Dis Child. 2011;96:354–60.

Rammohan M, Airan B, Bhan A, Sharma R, Srivastava S, Saxena A, et al. Total correction of tetralogy of Fallot in adultssurgical experience. Intern J Cardiol. 1988;63(2):121-8.

Jalali KS, Morsy MMF, Salim SS, Alnajjar AA, Khosh-Hal SQ, Sayed AU. Types of Surgical Repair and Outcome in Patients with Tetralogy of Fallot: Experience from A Single Center in Saudi Arabia.The Egyp J Hospital Med. 2018;71:3171-3178.

Nora JJ, Nora AH. Genetic and environmental factors in the etiology of congenital heart diseases. South Med J. 1976;69:919-26.

Li J, Soukias ND, Carvalho JS, Ho SY. Coronary arterial anatomy in tetralogy of Fallot: Morphological and clinical correlations. Heart. 1998;80:174-83.

Ylitalo P, Nieminen H, Pitkänen OM, Jokinen E, Sairanen H. Need of transannular patch in tetralogy of Fallot surgery carries a higher risk of reoperation but has no impact on late survival: results of Fallot repair in Finland. Eur J Cardiothorac Surg. 2015;48(1):91-7.

Pacifico AD, Kirklin JW, Blackstone EH. Surgical management of pulmonary stenosis in tetralogy of Fallot. J Thorac Cardiovasc Surg. 1977;74(3):382-95.

Vobecky SJ, Williams WG, Trusler GA, Coles JG, Rebeyka IM, Smallhorn J, et al. Survival analysis of infants under age 18 months presenting with tetralogy of Fallot. Ann Thorac Surg. 1993;56(4):944-9.

Mavroudis CD, Frost J, Mavroudis C. Pulmonary valve preservation and restoration strategies for repair of tetralogy of Fallot. Cardiol Young. 2014;24(6):1088-94.

Sen DG, Najjar M, Yimaz B, Levasseur SM, Kalessan B, Quaegebeur JM, et al. Aiming to Preserve Pulmonary Valve Function in Tetralogy of Fallot Repair: Comparing a New Approach to Traditional Management. Pediatr Cardiol. 2016;37(5):818–25.

Olley PM. Follow-up of children treated with intracardiac repair for Tetralogy of Fallot. In: Kidd BSL, Keit JD, eds. The natural history and progress in treatment of congenital heart defect. Springfield: Charles. C Thomas Publisher; 1971:195.

Dittrich S, Vogel M, Dähnert I, Berger F, Alexi-Meskishvili V, Lange PE. Surgical repair of tetralogy of Fallot in adults today. Clin Cardiol. 1999;22(7):460-4.

Lee C, Lee CN, Kim SC, Lim C, Chang YH, Kang CH, et al. Outcome after one-stage repair of tetralogy of Fallot. J Cardiovasc Surg (Torino). 2006;47(1):65-70.

Knauth AL, Gauvreau K, Powell AJ, Landzberg MJ, Walsh EP, Lock JE, et al. Ventricular size and function assessed by cardiac MRI predict major adverse clinical outcomes late after tetralogy of Fallot repair. Heart. 2008;94(2):211–6.

Benbrik N, Romefort B, Le Gloan L, Warin K, Hauet Q, Guerin P, et al. Late repair of tetralogy of Fallot during childhood in patients from developing countries. Eur J Cardiothorac Surg. 2015;47(3):e113–7.

Sachdev MS, Bhagyavathy A, Varghese R, Coelho R, Kumar RS. Right ventricular diastolic function after repair of tetralogy of Fallot. Pediatr Cardiol. 2006;27(2):250–5.

Ho KW, Tan RS, Wong KY, Tan TH, Shankar S, Le Tan J: Late complications following tetralogy of Fallot repair: the need for long-term follow-up. Annals Acad Med Singapore. 2007;36(11):947.

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Published

2020-11-27

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Original Research Articles