Surgery for tetralogy of Fallot

Surgery for tetralogy of Fallot Tetralogy of Fallot is the commonest cyanotic congenital heart disease. Surgical repair has improved remarkably ever since it was first published in 1955 by Lillehei CW et al [1]. Excellent long term survival is now feasible, with 30 year survival ranging from 68.5% to 90.5% [2]. Symptomatic infants with tetralogy of Fallot can undergo either primary surgical repair or a palliative procedure which could be either a systemic to pulmonary shunt or catheter based right ventricular outflow tract or pulmonary valve dilatation [3]. A retrospective study using the UK National Congenital Heart Disease Audit had 1662 infants with mean age of 181 days from 2000 to 2013. Of these 1244 underwent primary surgical repair, 311 surgical systemic to pulmonary shunts and 107 right ventricular outflow tract dilatation procedures. Mortality was higher in those who underwent primary repair before 60 days of age. Mortality at 12 years was 18.7% in those repaired before the age of 60 days vs 2.2% for those repaired after that. Right ventricular outflow tract dilatations was associated with more right ventricular outflow tract reinterventions and fewer pulmonary valve replacements at 12 years. They had lower mortality after complete repair. While considering procedures in early life, each has its own disadvantages. Early primary repair can increase the need for transannular patch and late morbidity, mostly due to pulmonary regurgitation. Surgical shunts have high rat...
Source: Cardiophile MD - Category: Cardiology Authors: Tags: Cardiac Surgery Source Type: blogs