Comparison of treatment strategies for neonates with tetralogy of Fallot and pulmonary atresia

Neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) but no major aorta-pulmonary collaterals are dependent on the arterial duct for pulmonary blood flow and require early intervention, either by primary (PR) or staged repair (SR) with initial palliation (IP) followed by complete repair...

Full description

Saved in:
Bibliographic Details
Published inThe Journal of thoracic and cardiovascular surgery Vol. 166; no. 3; pp. 916 - 925.e6
Main Authors Meadows, Jeffery J, Bauser-Heaton, Holly, Petit, Christopher J, Goldstein, Bryan H, Qureshi, Athar M, McCracken, Courtney E, Kelleman, Michael S, Nicholson, George T, Law, Mark A, Zampi, Jeffrey D, Shahanavaz, Shabana, Chai, Paul J, Romano, Jennifer C, Batlivala, Sarosh P, Maskatia, Shiraz A, Asztalos, Ivor B, Eilers, Lindsay, Kamsheh, Alicia M, Healan, Steven J, Smith, Justin D, Ligon, R Allen, Dailey-Schwartz, Andrew, Pettus, Joelle A, Pajk, Amy L, Glatz, Andrew C, Mascio, Christopher E
Format Journal Article
LanguageEnglish
Published United States 01.09.2023
Subjects
Online AccessGet full text

Cover

Loading…
More Information
Summary:Neonates with tetralogy of Fallot and pulmonary atresia (TOF/PA) but no major aorta-pulmonary collaterals are dependent on the arterial duct for pulmonary blood flow and require early intervention, either by primary (PR) or staged repair (SR) with initial palliation (IP) followed by complete repair (CR). The optimal approach has not been established. Neonates with TOF/PA who underwent PR or SR were retrospectively reviewed from the Congenital Cardiac Research Collaborative. Outcomes were compared between PR and SR (IP + CR) strategies. Propensity scoring was used to adjust for baseline differences. The primary outcome was mortality. Secondary outcomes included complications, length of stay, cardiopulmonary bypass and anesthesia times, reintervention (RI), and pulmonary artery (PA) growth. Of 282 neonates, 106 underwent PR and 176 underwent SR (IP: 144 surgical, 32 transcatheter). Patients who underwent SR were more likely to have DiGeorge syndrome and greater rates of mechanical ventilation before the initial intervention. Mortality was not significantly different. Duration of mechanical ventilation, inotrope use, and complication rates were similar. Cumulative length of stay, cardiopulmonary bypass, and anesthesia times favored PR (P ≤ .001). Early RI was more common in patients who underwent SR (rate ratio, 1.42; P = .003) but was similar after CR (P = .837). Conduit size at the time of CR was larger with SR. Right PA growth was greater with PR. In neonates with TOF/PA, SR is more common in greater-risk patients. Accounting for this, SR and PR strategies have similar mortality. Perioperative morbidities, RI, and right PA growth generally favor PR, whereas SR allows for larger initial conduit implantation.
Bibliography:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
content type line 23
ISSN:0022-5223
1097-685X
DOI:10.1016/j.jtcvs.2023.01.008