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Does interatrial communication affect post-operative course of children undergoing tetralogy of Fallot repair? Single centre retrospective cohort study: propensity score matching
Published online by Cambridge University Press: 05 November 2021
Abstract
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.
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.
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).
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.
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- © The Author(s), 2021. Published by Cambridge University Press
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.