Tetralogy of Fallot: Surgical management individualized to the patient

Citation
Cd. Fraser et al., Tetralogy of Fallot: Surgical management individualized to the patient, ANN THORAC, 71(5), 2001, pp. 1556-1563
Citations number
28
Categorie Soggetti
Cardiovascular & Respiratory Systems","Medical Research Diagnosis & Treatment
Journal title
ANNALS OF THORACIC SURGERY
ISSN journal
00034975 → ACNP
Volume
71
Issue
5
Year of publication
2001
Pages
1556 - 1563
Database
ISI
SICI code
0003-4975(200105)71:5<1556:TOFSMI>2.0.ZU;2-Z
Abstract
Background. Over the past four decades, the surgical trend has been toward early, complete repair of tetralogy of Fallot (TOF). Many centers currently promote all neonates for total correction irrespective of anatomy and symp toms, with some surgeons advocating hypothermic circulatory arrest for repa ir in small infants. We believe this approach increases morbidity. Methods. Based on approximately 40 years' experience in 2,175 patients, we developed a management protocol focused on patient size, systemic arterial saturations, and anatomy. Symptomatic patients (hypercyanotic spells, ducta l dependent pulmonary circulation) weighing less than 4 kg undergo palliati ve modified Blalock-Taussig shunt (BTS) followed by complete repair at 6 to 12 months. Asymptomatic patients, weighing less than 4 kg who have threate ned pulmonary artery isolation, undergo BTS and repair at 6 to 12 months. A ll other patients undergo complete repair after 6 months. Results. From July 1, 1995, to December 1, 1999, 144 patients underwent ope ration for TOF (129 patients) or TOF with atrioventricular septal defect (T OF/AVSD, 15 patients). Ninety-four patients underwent one stage complete re pair (88 TOF, 6 TOF/AVSD). Thirty-nine patients underwent repair after init ial BTS (32 TOF, 7 TOF/ AVSD). Ten patients are awaiting repair after BTS. The mean age and weight at complete repair were 18 months and 9 kg. There w ere no operative deaths. There have been 3 late deaths with complete follow -up (mortality 3 of 144 [2.1%]). Four of 133 patients (3%) have required re operation after total correction. Conclusions. This management strategy optimizes outcomes by individualizing the operation to the patient. Advantages include avoidance of circulatory arrest, low morbidity and mortality, and low incidence of reoperation after complete repair. (Ann Thorac Surg 2001;71:1556-63) (C) 2001 by The Society of Thoracic Surgeons.