Results of elective repair at 6 months or younger in 277 patients with tetralogy of Fallot: a 14-year experience at a single center

Roxanne E Kirsch; Andrew C Glatz; J William Gaynor; Susan C Nicolson; Thomas L Spray; Gil Wernovsky; Geoffrey L Bird

doi:10.1016/j.jtcvs.2013.03.033

Results of elective repair at 6 months or younger in 277 patients with tetralogy of Fallot: a 14-year experience at a single center

J Thorac Cardiovasc Surg. 2014 Feb;147(2):713-7. doi: 10.1016/j.jtcvs.2013.03.033. Epub 2013 Apr 18.

Authors

Roxanne E Kirsch¹, Andrew C Glatz², J William Gaynor³, Susan C Nicolson⁴, Thomas L Spray³, Gil Wernovsky⁵, Geoffrey L Bird⁵

Affiliations

¹ Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa. Electronic address: kirschr@email.chop.edu.
² Division of Cardiology, Department of Pediatrics, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa.
³ Division of Cardiothoracic Surgery, Department of Pediatric Surgery, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa.
⁴ Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa.
⁵ Division of Critical Care, Department of Anesthesiology and Critical Care Medicine, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa; Division of Cardiology, Department of Pediatrics, Cardiac Center at the Children's Hospital of Philadelphia, Philadelphia, Pa.

PMID: 23602127
DOI: 10.1016/j.jtcvs.2013.03.033

Abstract

Objective: To report practice and outcomes in infants undergoing elective repair of tetralogy of Fallot.

Methods: A review of a retrospective cohort of elective complete repair of infants age 6 months or younger from 1995 to 2009 was performed. Patients were excluded because of previous interventions, hypercyanotic episodes, intensive care admissions, additional major cardiac defects, or if they were not discharged after birth. Length of stay, mortality, and complications were recorded. Association was determined using logistic or linear regression models and univariate testing determined the multivariate model.

Results: There were 277 patients included. The hospital mortality rate was zero. A total of 87.4% of patients were discharged home within 7 days of repair, and 21.6% of patients were discharged on or before the third postoperative day. The postoperative course was uncomplicated in 245 patients (88.4%). Longer support time was associated independently with increased odds of complications (P < .001). Longer support time, younger age, chromosomal abnormality, and presence of a complication were associated independently with a longer hospital stay (all P < .001). Patients younger than 3 months (n = 110) had a longer median hospital stay (4 vs 3 days; P < .001) and longer support times (77.3 ± 35.1 min vs 66.4 ± 34 min; P < .01).

Conclusions: Elective tetralogy of Fallot repair was performed at 6 months or younger with low morbidity, no hospital mortality, and an 11.6% complication rate. Longer support times, lower weight, chromosomal abnormalities, and complications were associated with a significantly increased duration of hospital stay.

Keywords: 20; 41.1; ACC; CPB; DHCA; LOS; LSCA; RAA; TOF; TST; aortic cross-clamp; cardiopulmonary bypass; deep hypothermic circulatory arrest; left subclavian artery; length of stay; right aortic arch; tetralogy of Fallot; total support time.

MeSH terms

Age Factors
Cardiac Surgical Procedures* / adverse effects
Chi-Square Distribution
Elective Surgical Procedures
Female
Humans
Infant
Infant, Newborn
Length of Stay
Linear Models
Logistic Models
Male
Multivariate Analysis
Odds Ratio
Philadelphia
Retrospective Studies
Risk Factors
Tetralogy of Fallot / diagnosis
Tetralogy of Fallot / surgery*
Time Factors
Treatment Outcome