Hostname: page-component-586b7cd67f-r5fsc Total loading time: 0 Render date: 2024-11-28T07:13:39.673Z Has data issue: false hasContentIssue false
  • English
  • Français

Does interatrial communication affect post-operative course of children undergoing tetralogy of Fallot repair? Single centre retrospective cohort study: propensity score matching

Part of: Surgery

Published online by Cambridge University Press:  05 November 2021

Mohamed S. Kabbani Open the ORCID record for Mohamed S. Kabbani [Opens in a new window] ,
Abdulraouf Jijeh ,
Obayda M. Diraneyya ,
Fatimah A. Basakran ,
Najla S. Bin Sabbar ,
Anis Fatima ,
Sheikah M. AlEraij ,
Wafa A. Alshahrani ,
Husam I. Ardah  and
Ghassan A. Shaath
Mohamed S. Kabbani*
Affiliation:
Cardiac Science Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
Abdulraouf Jijeh
Affiliation:
Cardiac Science Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Obayda M. Diraneyya
Affiliation:
Cardiac Science Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Fatimah A. Basakran
Affiliation:
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Najla S. Bin Sabbar
Affiliation:
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Anis Fatima
Affiliation:
Cardiac Science Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
Sheikah M. AlEraij
Affiliation:
Department of Family Medicine, King Saud University Medical City, Riyadh, Saudi Arabia
Wafa A. Alshahrani
Affiliation:
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
Husam I. Ardah
Affiliation:
King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia Department of Biostatistics and Bioinformatics, King Abdullah International Medical Research Center, Riyadh, Saudi Arabia
Ghassan A. Shaath
Affiliation:
Cardiac Science Department, King Abdulaziz Medical City, Riyadh, Saudi Arabia
*
Author for correspondence: M. S. Kabbani, Cardiac Science, King Abdulaziz Medical City, Riyadh, Saudi Arabia. Tel: +9661118011111 ext 13621; Fax: +966118011111 ext 16773. E-mail: [email protected]
Get access Rights & Permissions [Opens in a new window]

Abstract

Introduction:

During tetralogy of Fallot repair, leaving or even create an interatrial communication may facilitate post-operative course particularly with right ventricle restrictive physiology. The aim of our study is to assess the influence of atrial communication on post-operative course of tetralogy of Fallot repair.

Methods:

Retrospectively, we studied all children who had tetralogy of Fallot repair (2003–2018). We divided them into two groups: tetralogy of Fallot repair with interatrial communication (TOFASD) group and tetralogy of Fallot repair with intact atrial septum (TOFIAS) group. We performed propensity match score for specific pre- or intra-operative variables and compared groups for post-operative outcome variables. Secondarily, we looked for right ventricle restrictive physiology incidence and influence of early repair performed before 3 months of age on post-operative course.

Results:

One hundred and sixty children underwent tetralogy of Fallot repair including (93) cases of TOFIAS (58%) and (67) cases of TOFASD (42%). With propensity matching score, 52 patients from each group were compared. Post-operative course was indifferent in term of positive pressure ventilation time, vasoactive inotropic score, creatinine and lactic acid levels, duration and amount of chest drainage and length of intensive care unit and hospital stay. Right ventricle restrictive physiology occurred in 38% of patients with no effects on outcome. 12/104 patients (12%) with early repair needed longer pressure ventilation time (p = 0.003) and intensive care unit stay (p = 0.02).

Conclusion:

Leaving interatrial communication in tetralogy of Fallot repair did not affect post-operative course. As well, right ventricle restrictive physiology did not affect post-operative course. Infants undergoing early tetralogy of Fallot repair may require longer duration of positive pressure ventilation time and intensive care unit stay.

Keywords

Tetralogy of Fallotinteratrial communicationatrial septal defectchildren
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 9 , September 2022 , pp. 1456 - 1461
Check for updates
Copyright
© The Author(s), 2021. Published by Cambridge University Press

Access options

Get access to the full version of this content by using one of the access options below. (Log in options will check for institutional or personal access. Content may require purchase if you do not have access.)

Footnotes

Central message Right ventricle restrictive physiology may complicate tetralogy of Fallot post-operative course. Leaving interatrial communication surgically to ameliorate right ventricle restrictive physiology and post-operative course did not affect post-operative course and outcome.

Perspective statement Almost 40% of children undergoing tetralogy of Fallot (TOF) repair suffer right ventricle restrictive physiology. Keeping interatrial communication (TOFASD) may benefit post-operative course. In retrospective cohort study: one-to-one propensity score matching, group with TOFASD versus group with TOFIAS had both similar post-operative course and outcome except for transitional lower oxygen saturation in TOFASD group.

References

Sandeep, B, Huang, X, Xu, F, Su, P, Wang, T, Sun, X. Etiology of right ventricular restrictive physiology early after repair of tetralogy of Fallot in pediatric patients. J Cardiothorac Surg 2019; 14: 84.CrossRefGoogle ScholarPubMed
Cullen, S, Shore, D, Redington, A. Characterization of right ventricular diastolic performance after complete repair of tetralogy of Fallot. Restrictive physiology predicts slow postoperative recovery. Circulation 1995; 91: 1782–1789.CrossRefGoogle ScholarPubMed
Munkhammar, P, Cullen, S, Jogi, P, de Leval, M, Elliott, M, Norgard, G. Early age at repair prevents restrictive right ventricular (RV) physiology after surgery for tetralogy of Fallot (TOF): diastolic RV function after TOF repair in infancy. J Am Coll Cardiol 1998; 32: 1083–1087.CrossRefGoogle ScholarPubMed
Laudito, A, Graham, EM, Stroud, MR, et al. Complete repair of conotruncal defects with an interatrial communication: oxygenation, hemodynamic status, and early outcome. Ann Thorac Surg 2006; 82: 1286–1291, discussion 91.CrossRefGoogle ScholarPubMed
Pigula, FA, Khalil, PN, Mayer, JE, del Nido, PJ, Jonas, RA. Repair of tetralogy of Fallot in neonates and young infants. Circulation 1999; 100: 2.ii–157. DOI 10.1161/01.cir.100.suppl.CrossRefGoogle ScholarPubMed
Gaies, MG, Gurney, JG, Yen, AH, et al. Vasoactive-inotropic score as a predictor of morbidity and mortality in infants after cardiopulmonary bypass. Pediatr Crit Care Med 2010; 11: 234–238.CrossRefGoogle ScholarPubMed
Sachdev, MS, Bhagyavathy, A, Varghese, R, Coelho, R, Kumar, RS. Right ventricular diastolic function after repair of tetralogy of Fallot. Pediatr Cardiol 2006; 27: 250–255.CrossRefGoogle ScholarPubMed
Samyn, MM, Kwon, EN, Gorentz, JS, et al. Restrictive versus nonrestrictive physiology following repair of tetralogy of Fallot: is there a difference? J Am Soc Echocardiogr 2013; 26: 746–755.CrossRefGoogle ScholarPubMed
Ad, N, Birk, E, Barak, J, Diamant, S, Snir, E, Vidne, BA. A one-way valved atrial septal patch: a new surgical technique and its clinical application. J Thorac Cardiovasc Surg 1996; 111: 841–848.CrossRefGoogle ScholarPubMed
Sousa Uva, M, Lacour-Gayet, F, Komiya, T, et al. Surgery for tetralogy of Fallot at less than six months of age. J Thorac Cardiovasc Surg 1994; 107: 1291–1300.Google ScholarPubMed
Loomba, RS, Buelow, MW, Woods, RK. Complete repair of tetralogy of Fallot in the neonatal versus non-neonatal period: a meta-analysis. Pediatr Cardiol 2017; 38: 893–901. DOI 10.1007/s00246-017-1579-8.CrossRefGoogle ScholarPubMed