Korean J Thorac Cardiovasc Surg.  2016 Feb;49(1):9-14. 10.5090/kjtcs.2016.49.1.9.

Repair of Tetralogy of Fallot in Infancy via the Atrioventricular Approach

• Bigdelian
• Sedighi M

• KMID: 2154330
• DOI: http://doi.org/10.5090/kjtcs.2016.49.1.9

Abstract

BACKGROUND
Tetralogy of Fallot (TOF) is a well-recognized congenital heart disease. Despite improvements in the outcomes of surgical repair, the optimal timing of surgery and type of surgical management of patients with TOF remains controversial. The purpose of this study was to assess outcomes following the repair of TOF in infants depending on the surgical procedure used.
METHODS
This study involved the retrospective review of 120 patients who underwent TOF repair between 2010 and 2013. Patients were divided into three groups depending on the surgical procedure that they underwent. Corrective surgery was done via the transventricular approach (n=40), the transatrial approach (n=40), or a combined atrioventricular approach (n=40). Demographic data and the outcomes of the surgical procedures were compared among the groups.
RESULTS
In the atrioventricular group, the incidence of the following complications was found to be significantly lower than in the other groups: complete heart block (p=0.034), right ventricular failure (p=0.027) and mediastinal bleeding (p=0.007). Patients in the atrioventricular group had a better postoperative right ventricular ejection fraction (p=0.001). No statistically significant differences were observed among the three surgical groups in the occurrence of tachycardia, renal failure, and tricuspid incompetence. The one-year survival rates in the three groups were 95%, 90%, and 97.5%, respectively (p=0.395).
CONCLUSION
Combined atrioventricular repair of TOF in infancy can be safely performed, with acceptable surgical risk, a low incidence of reoperation, good ventricular function outcomes, and an excellent survival rate.

Keyword

Tetralogy of Fallot; Cardiopulmonary bypass; Congenital abnormalities

MeSH Terms

Cardiopulmonary Bypass
Congenital Abnormalities
Heart Block
Heart Defects, Congenital
Hemorrhage
Humans
Incidence
Infant
Renal Insufficiency
Reoperation
Retrospective Studies
Stroke Volume
Survival Rate
Tachycardia
Tetralogy of Fallot*
Tricuspid Valve Insufficiency
Ventricular Function